Minimally Invasive Mitral Valve Surgery
Liverpool Heart and Chest Hospital is one of only a few hospitals in the UK that performs minimally invasive mitral valve surgery.
The conventional way to approach the mitral valve is through a 12 inch cut on the front of the chest (median sternotomy, Figure 1). This gives very wide exposure for the surgeon but is very invasive for the patient and takes two to three months to recover from. Additionally, there are a number of important lifestyle limitations after this, which give time for the breast bone to heal back together:
- No driving for six weeks
- No lifting of anything heavier than a bag of sugar for six weeks
- No pushing up from a bed or chair with your arms for six weeks
With the minimally invasive procedure, the surgeon uses a 2-3 inch cut on the right side of the chest and gently opens the space up between the ribs in order to see the heart. A high-definition video camera is then used to guide the procedure inside the heart. There are a number of benefits to this approach;
- The recovery period is an average of about three weeks before the patient is back to normal activity
- Less post-operative discomfort, particularly with the use of catheters that numb the pain nerves where the incision is placed
- Slightly shorter hospital stay (about four days)
- Lower chance of wound infection
- Superb cosmetic results, particularly in females where the scar is hidden under the right breast (Figure 2)
- The patient can drive again after two weeks
- Restrictions and limitations on lifting and pushing up from a bed/chair do not apply
Valve Surgery for Men
The cosmetic result of the minimally invasive procedure in men (A). In men a 2-3 inch scar is visible under the right nipple.
Valve Surgery for Women
The cosmetic result of the minimally invasive procedure in women (B). In women there is virtually no visible scarring as the incision is hidden under the right breast allowing a bikini to be worn with no visible evidence the patient has had open heart surgery.
Am I eligible for the minimally invasive technique?
Most mitral and tricuspid valve repairs and replacements can be undertaken through this approach, although the most complex valves to repair are probably still best appraoached through a sternontomy (your surgeon will advise you on whether this is an option for you). Valve and ablation procedures (cryomaze) where an irregular heartbeat (atrial fibrillation) is corrected at the same time as the valve dysfunction are possible. Additionally, holes between the top two pumping chambers (atrial septal defects, ASD) and benign atrial tumours (myxomas) can be corrected / resected using this technique.
What are the risks?
The minimally invasive approach is just as safe as the conventional approach measured in terms of risk of dying and having a stroke. The evidence is consistent that these procedures take longer to perform, but despite this, patient recovery is much quicker.
In order to maintain safety there is always a 2% possibility of conversion to the conventional approach during the operation.
How do I get referred for this procedure?
For both NHS and private referrals, please contact Maria Chidlow:
Tel: 0151 600 1393
Fax: 0151 600 1246
Who is not eligible?
- Those who have had prior right lung surgery or radiotherapy to the right side of the chest
- Those with peripheral arterial disease
- Those who need concomitant bypass or aortic valve surgery
Q: I don't live in the Merseyside area, can I still be treated at Liverpool Heart and Chest Hospital?
A: Yes, due to Patient Choice patients in the NHS have the right to choose where they are treated.
Q: Is the heart-lung machine still needed?
A: Yes, we make a 2cm cut in the right groin to use the femoral vessels for cardiopulmonary bypass. This incision is placed in a skin crease so will be hardly visible afterwards.
Q: What are the long-term results?
A: This technique has been available in North America and Germany since the mid-1990s. The technique of valve repair once the surgeon gets to the valve is identical to those used during the conventional approach and the data we have so far suggests that there is no difference in long-term outcomes.
Q: Will I still need a coronary angiogram?
A: Yes, you will need the same pre-operative tests as someone who is having the conventional operation.
Q: Are any extra tests needed? If so, where will they performed?
A: Yes, you may be required to have a CT scan of the arteries in your body which will be performed in Liverpool at your convenience.
Q: How long is an average operation?
A: Approximatley five hours, but patients are kept sedated for a few hours after the operation on the Post-Operative Critical Care Unit.
Q: How long before my family can see me in the Critical Care Unit?
A: Once the nursing staff are happy with all your monitoring, two members of your family at any one time are welcome to sit by your bed, however, many families prefer to wait until the following day before visiting.