By Omeni Osian, MD
Ocala Health Heart & Lung Surgery
Heart surgery is common throughout the world with over 700,000 heart surgeries performed each year. Of those, 250,000 are heart valve repair or replacement surgeries. Traditionally, valve repair and replacement is completed by separating the chest bone and accessing the valve through an opening in the chest wall with a vertical incision running approximately 8-10 inches long. However, over the past two decades, through advances in medicine and patient demand, small incision surgery, sometimes referred to as “minimal access surgery” is now commonly being used to repair or replace heart valves with as little as a 3-4 inch surgical incision between the ribs.
There are four heart valves that control the flow of blood through a heart. They are called the aortic, mitral, pulmonary and tricuspid valves. The aortic and mitral valves are the two most common valves requiring surgical intervention. Heart valve disease occurs when one or more of the four heart valves is not fully doing its job, and causes blood to leak or flow in the wrong direction or a valve becomes narrowed, preventing the flow of blood through the heart. Valve-related problems can be due to birth defects, infections, a heart attack, or more commonly, age-related calcium deposits accumulating on the valve. Typical symptoms of valve disease include shortness of breath, fatigue, chest pain or pressure, episodes of passing out, and leg swelling. When left untreated, damaged valves can lead to congestive heart failure and a decrease in life expectancy.
Laparoscopic surgery has been successful in many other surgical specialties. This is also true for heart valve surgery, and therefore it is becoming more and more common throughout the world. When using smaller incisions to repair or replace a heart valve, the need to completely separate the breast bone (“crack the chest open”) is eliminated. Many studies have shown there are a number of benefits to this smaller incision surgery for valve repair and replacement, including less surgical trauma to the body, less pain and discomfort, shorter ICU and hospital stays, less costs, shorter ventilator time, decreased blood loss, decreased wound infection and complications, overall better cosmetic outcomes, and faster return to daily activities and active lifestyles.
The most common approach for minimal access valve surgery involves a small 3-4 inch incision in the right chest. The exposure requires dividing a single rib or space between the ribs for valve exposure. An additional 1-3 inch incision is made in the groin to allow for heart lung bypass during surgery. Using this exposure, surgeons can replace a leaky or very stenotic aortic valve. Leaky mitral valves can be repaired or replaced through the small incisions as well as a stenotic mitral valve. Small incision valve surgery procedures allow surgeons and cardiologists to manage patients who may not be good candidates for conventional large incision surgery due to other health issues or restrictions.
In addition to minimal access valve surgery, catheter-based valve surgery can be offered in select patients who are higher risk for conventional surgery. Together, a heart surgeon and cardiologist thread a self-expanding valve through a catheter placed in the groin or chest in order to fix severely stenotic aortic valves. Some mitral valve disorders can be managed in patients deemed too high-risk for surgery using this catheter-based procedure.
Advances in medicine have benefited many surgical patients with less invasive approaches. This is also true in patients who need heart valve repair or replacement. There are different minimal access surgery techniques used in valve disease, allowing for higher risk patients to tolerate a small incision surgery. Smaller and less invasive surgeries allow patients to recover easier, quicker, and return to their active lives in a shorter period of time.
When it comes to valve disease, patients are in a better position today to choose a treatment plan that best suits them, and to consider minimal access surgery. Minimal access surgery may not be appropriate for all centers, surgeons or patients. However, given the many benefits, patients with valve disease may want to consider discussing minimal access surgery with their healthcare specialists.