Minimally Invasive Valve Surgery

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Minimally Invasive Valve Surgery:
Patient Educational Video

Download a Minimally Invasive Valve Surgery for Patients PowerPoint Presentation

Standard open-heart surgery involves making an incision down the middle of a patient's chest from the lower neck to the upper abdomen.  This is usually 10-12 inches long and requires dividing the breast-bone or sternum.  Minimally invasive valve surgery uses advanced techniques to provide the same surgery through smaller incisions.  Click here to view surgery videos about minimally invasive valve surgery.

Benefits

  • Smaller incision/scar
  • Less bleeding
  • Earlier mobilization and return to work/lifestyle
  • Less trauma
  • Lower infection rate
  • Shorter hospital stay

The biggest reason we are doing minimally invasive valve surgery is patient demand.  Patients today are more educated and curious today than ever, and with the easy access of information on the Internet, patients are informed of their options and are requesting this procedure.

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Approaches and Techniques

Minimally invasive valve surgery is more complex and demanding than standard heart surgery, and many surgeons are not trained in its use or are uncomfortable performing it.  All surgeons would agree that if minimally invasive valve surgery is to be done, the patient must receive the same quality operation through the small incision that they would receive with a full incision.  With regards to mitral valve surgery, surgeons should be able to repair nearly 90% of degenerative mitral valve or ischemic mitral valve diseases, and this should not be compromised by the technique of surgery. 

 

Many different approaches to minimally invasive valve surgery have been developed:

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Parasternal

This means "beside the sternum" or breastbone.  This was one of the earliest techniques devised and was chiefly used for replacing the aortic valve. 

This involved removing cartilages along the right ribs as they joined the breast-bone, and this left something of a defect in the chest wall that made patients uncomfortable. 

This approach is not used much lately.


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Transecting sternal

This means "across the sternum" or breast-bone. 

Here a horizontal incision is made and the breast-bone is divided in half across it rather than down the middle. 

This was also used to replace the aortic valve, but often the two halves of the breast-bone did not heal together well, leaving an unstable chest wall. 

This approach is not used much lately.


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Lower partial sternotomy

In this approach, the lower half of the breast-bone is divided vertically.

This is chiefly used for mitral valve procedures, and some centers have achieved very good results with this.

 

 

 


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Port access

With this technique, multiple small incisions are made in the chest and a camera and other long instruments are inserted to assist in performing the valve surgery. 

The artery and vein in the groin called the femoral vessels are usually used to place the patient on the heart-lung machine.  The surgeon still manipulates the instruments and replaces the valve using his hands, and usually at least one incision must be made that is large enough to put through the valve or prosthetic ring.  This procedure often requires a good deal of extra equipment.


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Right thoracotomy

This is a popular approach and many surgeons have achieved good results with it. 

A small incision is made in the right chest for access to the heart and valves using long instruments. 

The femoral vessels must be used to place the patient on the heart-lung machine.

 


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Upper partial sternotomy

This is the approach we use at Central Florida Health Alliance hospitals. This involves a small incision made vertically in the middle of the chest.  The breast-bone or sternum is divided vertically from the top down but only partially. 

This approach does not require using the femoral vessels for the heart-lung machine. 

Standard instruments are used.  Any imaginable heart valve procedure may be done through this approach, including all procedures on the aortic, mitral, and tricuspid valves. 

The mitral valve can be repaired at the same rate as with a full incision.  Aortic aneurysms of the root, ascending aorta, and arch can be dealt with.  Heart tumors can be taken out.  The maze procedure for atrial fibrillation can be performed.

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