Saturday, February 4, 2023

Minimally Invasive Heart Valve Surgery

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Benefits Of Minimally Invasive Heart Valve Repair

Minimally Invasive Valve Repair

Advantages of minimally invasive valve repair include:

  • Reduced trauma from surgery
  • Reduced chance of infection
  • Faster recovery

Minimally invasive procedures are appropriate for many patients, but not everyone is a good candidate for this type of surgery. Some patients will need to undergo open-heart surgery instead.

A Leader In Heart Transplantation

The Heart Transplantation Program is one of the largest and most experienced in the nation. NewYork-Presbyterian has performed more heart transplants than any other hospital in the country: more than 2,500 adult and pediatric heart transplants since 1971. Our survival rates consistently meet or exceed the national average. Our transplant teams are especially experienced caring for people with serious, high-risk conditions.

Specialized Care For The Tiniest Hearts

NewYork-Presbyterians integrated Congenital Heart Center is one of the largest and most preeminent pediatric cardiology and cardiac surgery centers in the nation. Our patients come to us from across the country and around the world to seek the most advanced, safest, and proven treatments for congenital heart conditions. Our outcomes are among the best in the nation.

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What Are The Advantages Of Minimally Invasive Heart Surgery

Compared to open-heart surgery, minimally invasive heart surgery may offer benefits such as:

  • Faster recovery.
  • Lower risk of bleeding or infection.

Sometimes, your surgeon may switch to open techniques partway through surgery if they determine that the minimally invasive approach is no longer safe. This isnt common, but its important to understand that its possible.

Newer Heart Valve Surgery Options

Minimally Invasive Mitral Valve Surgery

One important reason to track any possible valve disease-related symptoms and get regular check-ups especially as we age is to ensure any developing valve problems can be identified and treated as soon as possible.

Medications can be prescribed to increase the hearts ability to pump blood which may help compensate for a valve that isnt working correctly. However, a diseased heart valve is a mechanical problem that cant be fixed with medication alone. Surgery is often needed to repair or replace the damaged valve. Untreated valve disease may lead to decreased heart function and limit future treatment options. Its important to discuss any symptoms with your health care provider.

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What Happens After A Minimally Invasive Aortic Valve Replacement

After your minimally invasive aortic valve replacement:

  • You will start your recovery in the ICU or a recovery room.
  • When you wake up, you might feel confused at first. You might wake up a couple of hours after the surgery, or a little later.
  • Most people notice relief of their symptoms right after surgery.
  • The team will carefully monitor your vital signs, such as your heart rate. They may hook you up to several machines so the nurses can check these more easily.
  • You may have a tube in your throat to help you breathe. This may be uncomfortable, and you wont be able to talk. Your doctor or nurse will usually remove the tube within 24 hours.
  • You may have a chest tube to drain excess fluid from your chest.
  • You may have small temporary pacemaker wires coming from your chest.
  • Bandages will cover your incision. These can usually come off within a couple of days.
  • You will feel some soreness, but you shouldnt feel severe pain. If you need it, you can ask for pain medicine.
  • In a day or two, you should be able to sit in a chair and walk with help.
  • You may perform breathing therapy to help remove fluids that collect in your lungs during surgery.
  • You will probably be able to drink liquids the day after surgery. You can have regular foods as soon as you feel ready to eat.
  • You may receive elastic stockings to help blood circulate through your leg veins.
  • You will probably need to stay in the hospital for 3 to 5 days.

After you leave the hospital:

Types Of Minimally Invasive Heart Valve Repair

Common types of heart valve repair include minimally invasive aortic surgery and minimally invasive mitral valve surgery. Heart valve repair can be performed in different ways, depending on your specific condition. Your physician will evaluate your valvular disease and assess the amount of damage to determine which procedure will best address your needs. All types of minimally invasive heart valve repair involve a surgeon accessing your heart through small incisions in between your rib bones.

There are two main types of minimally invasive heart-repair surgical procedures:

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Can Surgery Be Performed Using Keyhole Incisions

Patients with isolated mitral valve disease may be candidates for minimally invasive surgery, so long as they do not have clinically relevant aortic valve disease or coronary artery disease. Surgeons perform the operation by making only a small 4-6 cm incision on the right side of the chest instead of the large midline-incision and division of the sternum used traditional open surgery.

Small, 4-6 cm Incision on the Right Side of The Chest

The surgery is performed through the small space between the ribs. The heart-lung machine is inserted via a small incision in the groin, allowing the heart to be stopped during repair of the valve. A soft retractor is inserted, which gently opens the narrow space between the ribs, enabling the surgeon to insert the specialized minimally invasive instruments. An endoscope, ideally with a 3D camera, is inserted that will provide a high-resolution image of the mitral valve.

Using this technique, the stability of the chest is fully preserved, patients recover more quickly, and the minimal scar will be barely visible after the patient recovers.

Surgical Setup for Minimally Invasive Mitral Valve Surgery

About Heart Valve Surgery

MitraClip : Minimally Invasive Mitral Valve Repair

Your hearts four valves manage the flow of blood through your heart. A diseased heart valve may allow regurgitation, which means it allows blood to leak back through the valve in the wrong direction. Or it may be afflicted with stenosis, which means the valve doesnt open as well as it should, blocking blood flow. And when the mitral valve prolapses, that means it doesnt close tightly.

If you have a diseased heart valve, your cardiologist may recommend heart valve replacement or repair. During valve surgery, your surgical team stops your heart with medication and uses a heart-lung machine to oxygenate and circulate your blood. Your surgeon removes the damaged valve and sews a new valve in place. The replacement valve may come from an organ donor, but more often a mechanical valve, made of plastic and metal, is used.

Sometimes diseased valves can be repaired for example, if calcium deposits on the valve can be removed, the valve may be surgically reshaped, allowing it to close more effectively. If the valve opening is too big, it sometimes can be tightened with stitches.

We offer both open-chest valve surgery, which requires a large incision through the breastbone, and minimally invasive surgery, which can be accomplished through small incisions in the chest.

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What Happens After Minimally Invasive Mitral Valve Repair

You spend one to two days in the intensive care unit after a mitral valve repair. You may temporarily have drainage tubes in your chest to keep fluid from building up around your heart.

You move from the ICU to another hospital area to continue recovery for a few more days. Your surgical team helps you get up and walk a day or two after surgery. They may instruct you to perform breathing exercises to remove any fluid in your lungs. You can expect to spend up to five days in the hospital before returning home.

William P Clements Jr University Hospital

All heart surgeries take place in UT Southwesterns William P. Clements Jr. University Hospital, ranked the #1 hospital in Dallas-Fort Worth by U.S. News & World Report for six consecutive years.

Clements University Hospital brings together the knowledge, expertise, research, and innovation of a world-class medical institution into one remarkable facility with the patient at the center of it all.

  • 24 Surgical Suites

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Do You See Patients From Other States

Actually, we see patients from all over the world! Dallas has two major airports and our hospital is located only two miles from Dallas Love Field Airport. Steva and Nelly our intake coordinators work with out-of-town patients all the time. They take care of coordinating benefits, making sure we have the required tests sent over from your providers, and even offer sound technical support because our first appointment is always conducted via telemedicine.

This makes getting a second opinion for out-of-state patients incredibly easy. Since our patients spend an average of only three days after surgery in the hospital, and because pain management is considerably less challenging due to our small incision, our patients are cleared to travel shortly after leaving the hospital.

Adult Congenital Heart Disease

Minimally Invasive Mitral Valve Surgery

NewYork-Presbyterian has one of the few programs in the country with the expertise to care for the most complex cases of adult congenital heart disease. We have extraordinary experience performing heart surgery and other treatments for adults with congenital heart disease who were initially treated as children, as well as those who were diagnosed later in their livesmany of whom come to us from around the world. We also have programs for people with special needs, such as pregnant women with congenital heart disease.

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Why Might I Need A Minimally Invasive Aortic Valve Replacement

This procedure may be needed if your aortic valve is working poorly. This may happen if you have aortic valve stenosis or aortic valve regurgitation.

  • In aortic stenosis, the valve is unable to open fully. This means less blood is able to exit the heart.
  • In aortic regurgitation, the valve is leaky. Some blood leaks back through the valve instead of moving out to the rest of the body.

In both of these cases, you may need to have your aortic valve replaced. A poorly working aortic valve may lead to symptoms such as:

  • Shortness of breath
  • An unpleasant awareness of your heartbeat

If these symptoms continue, surgery may be needed. Your healthcare provider may recommend the surgery even if you dont have significant symptoms. Surgery is most effective before symptoms become severe.

Both aortic stenosis and aortic regurgitation can happen because of general aging of the valve. Other causes of aortic valve disease include:

  • Heart birth defects
  • Bacterial infection of the heart valve
  • Tear of the aorta
  • Aortic aneurysm
  • Certain genetic conditions

Minimally Invasive Heart Surgery

At Stanford Health Care, our expert surgeons use a minimally invasive approach whenever possible. Our team has extensive experience and specialization with this advanced technique. If we can perform a heart procedure without open-heart surgery, we will do it.

When you come to Stanford for minimally invasive heart surgery, you benefit from:

  • Experience from high volume: Whenever possible, we perform heart surgeries using a minimally invasive approach. That commitment means our surgeons have a superior level of experience and skill in these procedures.
  • Advanced technology: Our cardiovascular surgeons use innovative, high-resolution imaging technology in the operating room. This advanced equipment sends incredibly detailed, 3-D images of the beating heart to your surgeon in real time, for the most precise results possible as we operate.
  • Reputation: Our heart surgery program at Stanford is world-renowned for its pioneering work in a number of heart procedures: From the first adult heart transplant in the U.S., to the world’s first ventricular assist device. Now, were leading the way with new techniques for minimally invasive heart surgeries and applying this knowledge to some of the most complex cases.

Advisory: This brochure contains graphic images.

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What Is The Recovery Time After Minimally Invasive Mitral Valve Repair

You may feel more tired than usual for a few weeks after surgery. Your surgeon gives you instructions about when you can return to work and other activities at this follow-up appointment. Youll need to avoid heavy lifting for several weeks.

Your provider may also recommend that you complete a cardiac rehabilitation program. These programs help you increase your activity levels safely. They may also help you adopt healthier habits, such as a nutritious diet and regular exercise.

Support For Heart Failure

Minimally Invasive Robotic Mitral Valve Repair Animation

For more than 25 years, NewYork-Presbyterian has been a pioneer in mechanical support for people with advanced heart failure. Our Mechanical Circulatory Support Program has been helping patients benefit from ventricular assist devices which pump blood for a weak heartsince 1990. Our surgeons have played an integral role in the development of many groundbreaking devices, and perform one to two VAD implantations each weekone of the largest volumes nationwidewith survival rates that exceed the national average. To overcome long waiting lists for donor organs and other limitations, we have spearheaded an international effort to develop VADs that provide mechanical support for failing hearts.

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When Should I See My Healthcare Provider

See your healthcare provider right away if you experience any signs of complication after mitral valve surgery, including:

  • Drainage or pus around the incision site.
  • Excessive swelling or redness around the incision site.
  • Unusual swelling or fluid retention in your legs or feet.
  • Weight gain of more than 3 pounds in one week.

What To Expect During The Procedure

The procedure usually takes several hours.

You will receive general anesthesia so that you will not feel any pain or remember anything from your surgery.

During the surgery, you will be connected to a heart-lung bypass machine. This same machine is used in open-heart surgery. The bypass machine functions as your heart and lungs while you are asleep and maintains your blood flow.

The surgeon will make a small incision and may perform any of these repair functions:

  • Close any holes in the valve
  • Remove any excess tissue so the valve can close completely
  • Reconnect valve leaflets that have separated
  • Repair chords that control the valve leaflets

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What Is Minimally Invasive Heart Valve Repair

In minimally invasive valve-repair surgery, also called less invasive valve surgery , the surgeon makes a small incision in your chest that allows them to see the valve and repair the damage. This is different from open-heart surgery, where you would need a large incision through your chest and breastbone. Most patients recover much more quickly and experience fewer complications with minimally invasive surgery.

The heart has four valves: mitral valve, tricuspid valve, pulmonary valve, and aortic valve. The leaflets on the valves open and close during each heartbeat, which makes the blood flow in the correct direction. If the valves do not open and close efficiently, the flow of blood may be disrupted. Minimally invasive valve repair corrects the damage to the affected valve to restore cardiovascular health.

Comprehensive Coronary Artery Disease Treatment

Minimally Invasive Mitral Valve Repair Surgery Through a Lower Mini ...

Our cardiologists, interventional cardiologists, and heart surgeons are exceptionally skilled in the care of people with coronary artery disease. We treat some of the highest-risk and most complex patients, including people over age 80, those with other medical problems, and patients with very few treatment options.

  • Our interventional cardiologists achieve excellent results performing balloon angioplasty and stent insertion to open clogged heart arteries and restore blood flow.
  • If you need coronary artery bypass surgery, our heart surgeons are national leaders in this technique. You may be able to have the operation through small incisions off-pump surgery, which does not require a heart-lung machine or hybrid heart surgery, which combines bypass surgery with interventional techniques. Our surgeons are among the most experienced in the country performing minimally invasive and robotic heart operations.

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Traditional Surgery Vs Dr Doolabhs Approach

Dr. Doolabh offers an approach to heart valve repair that is dramatically different from what is typically performed: He doesnt cut through the breastbone.

Traditional heart valve surgery requires cutting through the breastbone while Dr. Doolabhs approach avoids the breastbone altogether with a small incision between the ribs.

Why The Procedure Is Performed

Aortic valve surgery is done when the valve does not work properly. Surgery may be done for these reasons:

  • Changes in your aortic valve are causing major heart symptoms, such as chest pain, shortness of breath, fainting spells, or heart failure.
  • Tests show that changes in your aortic valve are harming the work of your heart.
  • Damage to your heart valve from infection .

A minimally invasive procedure can have many benefits. There is less pain, blood loss, and risk for infection. You will also recover faster than you would from open heart surgery.

Percutaneous valvuloplasty and catheter-based valve replacement such as TAVR are done only in people who are too sick or at very high risk for major heart surgery. The results of percutaneous valvuloplasty are not long-lasting.

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What Happens During A Minimally Invasive Aortic Valve Replacement

Check with your healthcare provider about the details of your procedure. In general, during your minimally invasive aortic valve replacement:

  • An anesthesiologist will give you anesthesia before the surgery starts. This will cause you to sleep deeply and painlessly during the operation. Afterwards you wont remember it.
  • The operation will take several hours. Family and friends should stay in the waiting room, so the surgeon can update them.
  • There are several different approaches used in minimally invasive aortic valve replacement. These can include a small incision through your breastbone, to the right of your breastbone, or between the ribs on your side. Sometimes surgeons use special instruments and a camera to do the surgery. With this approach, your surgeon will make several small holes in your chest. Some surgeons use robot-controlled arms to perform the surgery. Your doctor will review all of your options with you along with their associated risks and benefits.
  • The surgery team will connect you to a heart-lung machine. This machine will act as your heart and lungs during the procedure.
  • Your surgeon will remove your current aortic heart valve and replace it with a new one.
  • The surgery team will remove you from the heart-lung machine.
  • The team will wire your breastbone back together .
  • The team will then sew or staple the incision in your skin in back together.

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