Minimally Invasive Heart Valve Surgery
Why Choose Minimally Invasive Heart Valve Surgery?
Minimally invasive surgery is an option for patients who need to have an aortic or mitral valve repaired or replaced. Patients with multiple valves damaged are also candidates. In addition, this approach has been used to close congenital defects (holes) in the heart, remove tumors in the atrium as well as repair aneurysms of the ascending aorta.
Compared to a standard open heart procedure, minimally invasive surgery (sometimes called “keyhole” or “port access” surgery) is associated with less pain, fewer blood transfusions, shorter intensive care unit and hospital stays, less scarring, fewer wound infections, smaller incisions, faster recovery, and increased patient satisfaction.
Techniques and instrumentation developed by our team allow for fewer overall complications putting Baylor College of Medicine at the forefront of minimally invasive
Why Heart Valve Surgery Is Performed
You may need surgery if your valve does not work properly due to:
- Aortic or mitral prolapse or regurgitation (leaking valve) is the term used when one or more of your heart valves do not close all the way allowing blood to leak back into the chamber of your heart where it initially entered.
- Aortic or mitral stenosis (blockage or narrowing or calcification of the valve) – one or more of your heart valves do not fully open, restricting blood flow
- Valve infection (infectious endocarditis)
- Some patients may not even have symptoms and still have an indication to have surgery on their valve.
Our multidisciplinary team will perform tests to detect if changes in your heart valves are beginning to harm your heart function or if you have any damage from infection (endocarditis).
About Surgery for Heart Valve Disease
Surgeries are performed at Baylor St. Luke’s Medical Center. Before your surgery, you will receive general anesthesia that will put you in a deep, pain-free sleep. During minimally invasive heart valve surgery, our surgeons will make small incisions between the ribs. The incisions used for this surgery are about five to six centimeters (two inches) which are much smaller than those required for traditional open heart surgery where the breastbone (sternum) is opened in the middle. Our minimally invasive approach does not involve entering or opening the breastbone at all. Instead, the muscles will be divided, allowing our surgeons to reach the valves in your heart. Thereafter our surgeons can repair or replace any of the affected heart valves. Essentially any complex mitral valve repair/replacement and any aortic valve replacement can be performed using this approach. You will need to be on the heart lung bypass machine for your heart valve surgery. This will require a small cut in your groin or chest area to place tubes that will be used to be connected to this machine
Valve repair is the preferred method by Baylor surgeons. The surgeon trims, shapes, or rebuilds one or more of the flaps that open and close the valve. There are a wide variety of techniques that are used and they will vary depending on the specific damage your valve had incurred. As one of the most experienced mitral valve repair teams in the country, we have been able to repair more than 95 percent of degenerative and rheumatic mitral valves. We consider a repair to be similar to a plastic surgical approach to the valve – since this is not only a science but an art as well.
Ring annuloplasty completes the repair and provides the long term stability of the mitral valve repair. Our surgeons will place a cloth-covered metal ring around the mitral valve with a series of individual sutures.
Heart Valve Replacement
You will need a new heart valve if your native valve has suffered too much damage to be repaired. This is called valve replacement surgery. Your damaged or diseased heart valve will be completely removed and a new one is sewn into place. There are two main types of new valves:
Mechanical – constructed from man-made materials, such as titanium and carbon. These valves are very durable. You will need to take blood-thinning medicine, such as warfarin (Coumadin), for the rest of your life. This valve requires monthly maintenance, which means blood tests every 4-6 weeks for life to be sure that your blood is thin enough so that the metal valve does not clot. This can lead to strokes or even be fatal.
Biological – made of animal tissue (cow or pig). These valves often last 15 to 20 years, depending on your age and other factors, but you may not need to take blood thinners for life. They will require that you take a daily aspirin. In some cases Coumadin may be prescribed for one to three months only.
The entire operative procedure may take three to four hours.
Outlook after Surgery for Heart Valve Disease
When waking up from the anesthesia in the recovery room, most patients will still have the breathing tube in place. We usually allow you to slowly wake up from the anesthesia in order to closely monitor your vital signs and response to the surgery. You will have in place two drainage tubes, a pacemaker wire and a pain pump. These will be removed within the first three days of surgery. The bladder catheter, which was inserted under anesthesia, will be left in place for 24 hours. Most patients are discharged from Baylor St. Luke’s Medical Center within three to five days after surgery.
Patients usually stay in the intensive care unit for the first day or two and are then moved to the hospital for additional monitoring. You should be walking a day after surgery. Our rehabilitation team is also involved in your care. The majority are discharged home although depending on their circumstances, some will require additional care and will be transferred to a specialty nursing facility or rehabilitation facility.
With minimally invasive heart valve surgery, patients generally experience less blood loss, less post-operative pain, and fewer infections than open sternotomy based procedures. All aspects of the recovery are faster. Your ability to perform the breathing exercises and ambulate (walk) will be easier and safer since the breastbone is not split. We will provide multiple measures for pain relief but keep in mind that pain is very subjective and individual. Our goal is to provide you and your family with the best experience under these stressful times.
We have experienced minimally invasive valve surgeons providing the latest and most innovative approaches to heart valve surgery.