Do you need to break the ribs?
It isn't necessary to break any ribs. For the minithoracotomy approach dividing the ligaments allows the surgeon to access the heart by going between the 3rd and 4th rib.
How do you see the mitral valve to work on it?
You get a great view of the mitral valve through a mini-thoracotomy incision. We use a mini-mitral retractor to help expose the mitral valve. We also routinely use a high definition camera to enhance the view of the mitral valve, so that the whole team can benefit from both magnified, detailed video images, as well as a direct view of the three dimensional reality.
Why is the mini-thoracotomy your preferred approach?
We prefer this approach to totaly endosopic or robotic approaches because it is so safe - the surgical team can see the entire mitral valve directly, without tissue or blood obscuring the visual field. The surgeon also has the advantage of tactile feedback, which is absent in robotic heart surgery and impaired in totally endoscopic (keyhole) surgery. Tactile feedback is a vital part of performing precise repairs on the delicate tissues of the mitral valve using the finest sutures and instruments.
Do you need a heart-lung (cardiopulmonary) bypass machine?
Yes - it is not possible to perform mitral valve surgery without using a heart-lung bypass machine. The patient is placed on the heart lung machine either via the groin vessels or through the same chest incision, allowing the heart to be opened safely.
In this way, a great cosmetic result can be achieved without compromising the quality and durability of the mitral valve surgery. Simple and more complex mitral valve repairs can be performed using gold-standard repair techniques developed in conventional open surgery, safely eliminating mitral regurgitation in a wide range of patients. Addressing other problems such as a patent foramen ovale (PFO) and tricuspid valve regurgitation at the same time is relatively straightforward using this approach.
Mini-mitral valve repairs are performed by a specialist team that has extensive training in conventional mitral valve repair, as well as the anesthetic and surgical techniques necessary to achieve the same excellent results through more cosmetic incisions. You can read more about Our Team here.
Who is eligible for Minimally Invasive Heart Surgery?
- Low midline incision: Any patient that does not require surgery on the ascending aorta. This is the option we use in most patients.
- Right mini-thoracotomy: Any patient with isolated mitral and / or tricuspid valve disease, who does not need coronary bypass grafts or aortic valve surgery. We prefer to reserve this approach for patients under 55 years of age.
Is anyone particularly suitable for a minithoracotomy approach?
Young, slim women with mitral and / or tricuspid valve disease are ideally suited to this approach. Women with a cup size greater than a B-cup will find that the incision is almost completely hidden in the breast crease. Wound healing in this area is poorer in older women with very large breasts.
Do you know before the surgery which approach you will use?
Yes. We confirm with all patients well before surgery what the approach will be. Very occasionally we will tell some patients that the final decision will be made based on evaluation of the transesophageal echocardiography findings once they are asleep.