Heart Valve Replacement With the Minimally Invasive Method

When a heart valve is too damaged to be repaired, we replace it with a prosthetic valve; in many patients we can now carry out that replacement through a small incision, using minimally invasive methods. In this article I will explain minimally invasive valve replacement.

Mitral and Aortic Valve Surgery With the Closed Method

For mitral valve replacement we use a mini-thoracotomy through the right underarm, and for aortic valve replacement we generally use the “upper mini-sternotomy” technique, in which only the upper half of the breastbone is opened. With both techniques, removing the valve and suturing in the new one is done with exactly the same meticulousness as in conventional surgery, simply through a smaller window.

Valve Repair With Endoscopic Imaging

When working through a small incision, instead of looking directly into the heart with the naked eye we use a slim camera (endoscope) and special long-handled instruments; thanks to the magnified image on the screen we can examine the valve structures more clearly than in conventional surgery. This technique allows us to maintain the same precision in both valve repair and valve replacement.

How Large Is the Surgical Scar?

In mitral valve replacement the scar is an incision of about 4-6 centimeters in the underarm area, easily hidden by clothing. With the upper mini-sternotomy used for the aortic valve, the scar takes the form of a shorter vertical line on the upper chest. In neither case is there the long scar running down the whole chest that conventional surgery leaves.

Frequently Asked Questions

Is minimally invasive valve replacement riskier than conventional replacement? When chosen for the right patient, mortality and major complication rates are similar to the conventional method; the real difference lies in pain, bleeding and speed of recovery.

Does this method change which type of valve (mechanical/biological) is used? No, the choice of valve type is made using the same criteria based on the patient’s age and lifestyle; only the route of access changes.

Can this method be used in every patient? No; in situations such as severe chest wall deformity, previous right lung surgery or very advanced hardening of the arteries, the conventional method may be safer.

Conclusion

In the right patient, minimally invasive valve replacement delivers a repair of the same quality as conventional surgery while leaving a far smaller scar and allowing a faster recovery. The decision is individualized according to the valve pathology and the patient’s anatomical suitability.

To find out whether your heart valve can be replaced with the minimally invasive method, you can book an appointment for a detailed examination and imaging assessment.

References

1. Falk V, Cheng DC, Martin J, et al. Minimally Invasive Versus Open Mitral Valve Surgery: A Consensus Statement of the International Society of Minimally Invasive Coronary Surgery (ISMICS) 2010. Innovations (Phila). 2011;6(2):66-76.
2. Cao C, Gupta S, Chandrakumar D, et al. A Meta-Analysis of Minimally Invasive Versus Conventional Mitral Valve Repair for Patients with Degenerative Mitral Disease. Ann Cardiothorac Surg. 2013;2(6):693-703.