Heart Valve Replacement: Minimally Invasive Methods

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Heart Valve Replacement: Minimally Invasive Methods

Topic Overview

Heart surgeons can also use less invasive methods for heart surgery. In conventional open-heart surgery, the surgeon makes a long incision [about 30 cm (12 in.)] from the top of the rib cage to just above the navel and then spreads the ribs to expose the heart. This type of incision is called a sternotomy.

In minimally invasive heart surgery, the surgeon makes an incision in the chest that is less than one-third of the size of the incision used for conventional heart surgery [less than 10 cm (4 in.)]. The aortic valve is located near the front of the chest. So surgeons have discovered that aortic valve replacement can be performed successfully through this smaller opening.

Surgeons may perform this minimally invasive surgery in different ways. These variations include different ways to:

  • Bypass the heart with a heart-lung machine.
  • Protect the heart during surgery.
  • Make the incision in the chest to access the heart.

Despite these variations, in all other ways the technique for replacing the aortic valve is the same in minimally invasive surgery as in conventional valve surgery.

What is the bypass method?

Another variation in technique that you may notice after surgery is the method that your surgeon uses to access one of the arteries and one of the veins to bypass the heart with a heart-lung machine. In many cases the surgeon will attach the heart-lung machine to a vein and artery in the chest. But in some minimally invasive surgery procedures, surgeons have experimented with different heart bypass methods. One method involves accessing the femoral artery, which is in the groin area at the top of the thigh. If your surgeon uses this method, you may experience some tenderness or soreness in the area where the tube was placed in your artery. But it appears that most surgeons still perform heart bypass through arteries and veins in the chest.

What are the potential benefits of minimally invasive valve replacement surgery?

Less invasive surgery can have benefits over conventional valve replacement surgery. These benefits include:

  • Less blood loss during surgery.
  • Reduced need for blood transfusions.
  • Reduced chance of irregular heartbeat during surgery.
  • Possibility of removing the breathing tube sooner after surgery.
  • Less pain during recovery from surgery.
  • Shorter hospital stay.
  • A smaller scar.
  • Lower risk of infection.
  • Easier treatment in cases of infection.
  • Quicker recovery and return to previous level of activity.
  • Lower overall risk of complications, including death.

What are the controversies over these benefits?

Researchers are still studying the results of minimally invasive surgery to figure out whether all these benefits can be attributed to this technique. Some studies have found that people who had minimally invasive surgery enjoyed many of these benefits. Other studies have found that there has not been a significant difference between minimally invasive surgery and conventional valve replacement surgery, at least in some areas of potential benefit.

Minimally invasive surgery can be safe and effective for the purposes of replacing the aortic valve. One drawback is that because this surgery is more technically complex, it often takes longer to complete. So far, this increase in time required for surgery does not appear to have had an impact on the effectiveness of the surgery. The one benefit that minimally invasive surgery is guaranteed to provide is a smaller scar, given that the incision is smaller. But it still remains to be seen whether the benefits consistently extend beyond this cosmetic benefit.

Should I consider minimally invasive valve replacement surgery?

Surgeons are still working to perfect minimally invasive surgery. Greater experience with this technique will likely decrease the time required for surgery and increase the chance that people who have this surgery will enjoy the benefits. Ask your doctor how many minimally invasive valve replacements he or she has performed.

Your decision to have minimally invasive surgery, if that option is available to you, should be based on your doctors' explanations of the benefits and any potential drawbacks of the surgery, which should be based on their experience and current medical literature. You should ask your surgeon about how minimally invasive surgery has benefited other people who had the surgery and what any recent studies have shown.

Also, ask your surgeon how many minimally invasive surgeries he or she has performed.

Whether you have the option of choosing to have minimally invasive surgery instead of conventional valve surgery will depend on several factors, including whether your:

  • Doctor recommends it.
  • Heart surgeon performs minimally invasive surgery and recommends it for you.
  • Provincial health plan or private insurance covers the procedure.

One important limitation of minimally invasive surgery is that if you also need to have coronary artery bypass surgery during your valve replacement surgery, minimally invasive surgery may not be an option because it does not provide sufficient access to your coronary arteries.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer George Philippides, MD - Cardiology
Specialist Medical Reviewer Andrew Swan, MD, CCFP, FCFP - Family Medicine
Last Revised January 28, 2010

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