Mitral valve surgery usually requires a long incision of six to eight inches made in the midline of your breastbone. The surgeon then saws through the breastbone to allow access to the heart. In some patients, it is possible to perform a mitral valve repair through a much smaller incision. Use of such small incisions is termed “minimally invasive surgery”. The advantage of a small incision is mainly cosmetic (the scars are smaller and less visible). In some patients, the pain after surgery may be reduced and recovery from surgery is faster when surgery is done through a smaller incision. Operating through small incisions is however more technically demanding and in some cases could reduce the safety of the procedure.

We offer minimally invasive surgery to selected patients. Not all patients are suitable for minimally invasive surgery. Patients who require additional cardiac procedures like coronary artery bypass surgery, elderly patients, patients with very diseased arteries, and patients with a very weakly contracting heart will not be suitable for this approach. Finally, our paramount objective is to ensure a good valve repair, with no residual leakage, at a low operative risk. Our surgeons will only perform a repair through a small incision when they believe they can do a good quality valve repair at a low risk to the patient; if the valve disease is complicated (as assessed by the echocardiogram) then we recommend a full incision as we believe a larger scar is preferable to an imperfect repair.

Ask the surgeon if this is an option for you.

Different approaches to minimally invasive surgery.

Lower Sternotomy

In this approach the surgeon makes a 3 to 4 inch incision over the lower aspect of the midline of the chest and divides only the lower portion of the breast bone to gain access to the valve. Through this incision we can perform most complex valve repairs. When fully healed the scar is concealed by clothing, even when the patient wears low-necked clothing. In some women the scar is well concealed by their brassiere. This incision has the advantage that if the surgeon encounters problems, he or she can easily extend the incision and divide the remaining breast-bone and convert to the standard approach.

Thoracotomy

In this approach the surgeon makes a 4 to 6 inch incision in the right side (instead of middle) of the chest and gains access to the heart by going through the ribs. Some women prefer this incision because the scar may be placed underneath the breast crease and is therefore largely concealed. Access to the heart may be difficult in some cases making it more difficult to achieve a perfect repair.

Robotic surgery

In this approach the surgeon performs the operation through several mini-incisions, the largest being about 2 inches, using assistance of a ‘robot’ and specially designed instruments to perform the operation. The surgeon sits at a console and controls the instruments which are mounted on the arms of a robot by another surgeon. Although cosmetically superior, this approach limits the complexity of repair that can be undertaken by the surgeon, and in some cases may compromise on the quality of repair. For this reason, we do not offer this approach at Mount Sinai as we cannot guarantee the same high standards of valve repair as we can with other approaches.

Low skin incisions

Patients who are concerned about cosmesis, but who are not suitable for minimally invasive surgery, can request a low incision. The surgeon can make the standard skin incision start an inch lower and yet perform full division of the breastbone. The scar will therefore not be visible when wearing normal clothing. Patients who cannot have a minimally invasive operation, but who are concerned about the scar, can also request the services of our plastic surgeon to cosmetically close the incision.