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The surgical approach to aortic valve disease has been dramatically improved upon by the introduction of minimally invasive aortic valve replacement techniques. Even the elderly and frail patients can enjoy a fast and painless recovery and return to their families and homes two to three days after surgery. The aortic valve is a one-way valve that opens into the Aorta, which is the main “pipeline” that comes out of the heart. There are two basic problems that can affect its function:
- If it does not open properly, the heart will struggle against the resistance offered by a closed and stiff valve that impairs the ability of the heart to empty out when it is contracting. We describe this condition as Aortic Valve Stenosis.
- On the opposite end of the spectrum the same valve might be “leaky” and not close well when the heart is reloading in between contractions. That makes the pumping action of the heart very inefficient because a good portion of the oxygenated blood that is pumped forward into the main pipeline will leak back into the heart. This condition is known as Aortic Valve Insufficiency or Regurgitation.
About 6% of the elderly U.S. population and a small percentage of the younger population is affected by these severe malfunctions of the aortic valve and need a life saving minimally invasive aortic valve replacement before it is too late. This article will outline the reasons why a minimally invasive aortic valve replacement is by far the best way to address these pathologies.
Unfortunately, most cardiac surgeons have not had the time, the willingness or the opportunity to learn these new minimally invasive aortic valve surgery techniques and are still using the old fashioned splitting of the breast bone (median sternotomy). In addition, they end up using blood transfusions in most of their surgical patients. This approach has many disadvantages, including slow wound healing, more wound infections, more postoperative pain and bleeding, a slow recovery from surgery and a poor cosmetic result with a 12″ to 14″ midline scar from the base of the neck to the bottom of the breast bone.
If an aortic valve replacement is what you need, these are the reasons WHY you should seek out a minimally invasive aortic valve replacement approach and a description of HOW we can perform open heart surgery through a tiny incision on the right side of the chest wall (minithoracotomy):
- No bone cutting at all. The incision opens a tiny space between two ribs and heals very well. Infections in this type of wound are almost unheard of.
- No pain. Small amounts of local anesthetic are injected in between the ribs and make this incision pain free. Our patients wake up pain-free after their minimally invasive aortic valve replacement
- Very little bleeding. This approach avoids the bleeding caused by bone cutting and by the larger incisions used in old fashioned surgery. Very few patients require any blood transfusion after a minimally invasive aortic valve replacement
- Fast recovery. Even the elderly and frail patients are back on their feet in less than 24 hours and can often go home two days after surgery.
- Excellent cosmetic results. All you have to show is a tiny 2″ thin scar on the right side of your chest. You would still be able to wear an open shirt, a blouse or an evening gown and that tiny scar will be completely out of sight. It is a very safe, accurate and precise way to perform a heart valve replacement.
Here is my warm piece of advice. If you need open heart surgery ASK about these minimally invasive options. Be specific about the fact that you want a minithoracotomy. If you are not offered these options it is worthwhile to get a second opinion in a Minimally Invasive Heart Surgery Center with advanced expertise in this type of surgery. After all, it’s your body, it’s your heart, it’s your life!
write by Duncan