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Minimally invasive aortic valve replacement
03/29/2006
In the past, heart surgery required a major incision in the chest and through the breastbone, and an equally major recovery period. But now, thanks to technological advances, some patients with aortic valve problems can undergo a minimally invasive surgical procedure to replace the valve.

“The procedure is newer but is being performed across the country. It’s still not as prevalent as more traditional approaches,” say Palmetto Health Heart Hospital cardiovascular surgeon Dr. Scott Petit.

The aortic valve is the last valve through which blood passes before it enters the aorta, the main blood vessel of the body. If the valve is not functioning correctly, blood leaks back into the left ventricle of the heart.

“Aortic valve problems are caused by the natural degeneration of the valve, or it can be congenitally abnormal at birth. Valves wear and tear with age. Most of the patients I see with aortic valve issues are in their 60s and 70s,” Dr. Petit says.

The standard procedure requires the breastbone to be cut in half, from top to bottom. During the minimally invasive approach, however, only the top third of the breastbone is allowed to open to one side. The incision is nearly half the size and greatly benefits the patient.

“During the surgery, the sternum stays more stable and internal organs are not moved around as much. Afterwards, the closure also is more stable,” says Dr. Petit.

The patient also loses less blood and experiences less long-term pain and discomfort from the incision. Recovery time is more rapid, so patients usually can look forward to spending only one week in the hospital, with two months recovery time overall.

Not everyone is a candidate for the minimally invasive procedure, however. Only if the aortic valve needs to be replaced and no other work needs to be done, such as a bypass, then this surgery is a good option.

More men than women are recommended for the procedure, because the incision is made higher on the chest wall. Even though the incision is smaller and made as low as possible, the breast area may be affected.

Dr. Petit is a proponent of the minimally invasive surgery because it provides another option for his patients.

“When it comes to the heart, there is no cookie cutter approach to heart surgery,” says Dr. Petit. “This is a good approach to any person in good health. If a patient is active in using his or her chest and arm muscles, this increases the likelihood of less soreness during and after recovery. Potentially, a patient can bounce back more quickly. I want to offer that to my patients.”