Keyhole Heart Surgery

Heart valves are vital to the proper functioning of the heart by maintaining the correct flow of blood through the heart. Valves which are not functioning correctly sometimes require repair or replacement.

If possible, the surgeon will look to repair the faulty valve but in some cases replacement is the only option. Surgery of this scale is performed at hospitals with specialist teams of cardiac surgeons, cardiologists and cardiac imaging.

The traditional method

The traditional method of valve surgery is to open the breastbone (sternum), via a sternotomy. This method gives the surgeon good access and visibility of the heart and has proven results so can be very effective for patients, it does however come with some drawbacks including long (3-6 months) recovery time, a 9-12 inch scar down the chest.

Keyhole heart surgery

Over recent years techniques have been developed to offer patients minimally invasive, keyhole surgery options for valve repair and replacement. Examples, which we have discussed previously, would be TAVI and MitraClip. Here we will discuss valve replacement surgery using a keyhole approach.

The aim of the outcome of the surgery is the same for traditional and minimally invasive surgery - the replace or repair the faulty valve. Whilst traditional surgery opens the chest via the sternum, minimally invasive heart valve surgery accesses the heart via a small incision (approx 5 cm) between the ribs on the right side of the chest. The surgeon then uses long, skinny instruments and cameras to navigate the chest cavity and reach the heart to perform the valve repair/replacement. Once inside the heart the procedure is the same as traditional surgery - the big difference is the approach and access to the heart.

What are some of the benefits of minimally invasive heart valve surgery?

• Quicker recovery time - most patients will be able to return to normal daily activities after about 3 weeks
• Reduced pain following the operation - due to smaller incision
• Shorter hospital stay - usually about 3-4 days
• Reduced infection risk
• Patients can usually drive after 4 weeks
• Cosmetically better results - scar is just 5 cm rather than the length of the chest

Who is suitable for minimally invasive heart valve surgery?

Many patients will be suitable for this minimally invasive approach. Some of the reasons why patients wouldn't be suitable include:

• Patients who have has surgery on their right lung before
• Patients who have had radiotherapy on their right lung
• Patients with peripheral arterial disease
• Patients who need by-pass surgery and valve surgery at the same time

As with all surgery minimally invasive heart valve surgery does carry risks and your surgeon will discuss these with you prior to any decisions being made.

It is important to note that only a handful of cardiac surgeons in the country perform minimally invasive cardiac surgery, Mr Deshpande being one of them.