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Minimally-invasive mitral valve surgery
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 mitral valve problems can undergo a minimally invasive surgical procedure that requires only a few very small incisions.

It’s called minimally invasive mitral valve surgery, and Palmetto Health Heart Hospital cardiovascular surgeon Dr. Scott Petit was the first in South Carolina and among the first in the country to perform the procedure.

Problems with the mitral valve are surprisingly common. One of four valves in the heart, the mitral valve allows fresh, oxygenated blood from the lungs to pass through the left atrium into the left ventricle, which then pumps the blood to the rest of the body. If blood starts to flow backwards, indicating a leak, or if the mitral valve opening is too narrow for the right amount of blood to pass through, mitral valve surgery can fix the problem.

“Mitral valve problems can be caused by aging or rheumatic diseases as a child. Or sometimes the mitral valve just is not formed properly,” says Dr. Petit.

The standard cardiovascular surgery used to correct mitral valve problems require the surgeon to make a 12- to 15-inch incision through the breastbone to divide the chest wall. Then the rib cage is spread to allow room for the surgeon’s hands to enter the chest cavity and access the heart. Recovery can be a lengthy process. It is not unusual for it to take several weeks or even months before the patient returns to normal life.

With the minimally invasive approach, the surgeon makes one or more one-inch incisions to the groin area and a four- to six-inch incision in the chest. The procedure is performed through these small incisions, eliminating the need for a lengthy incision.

Surgeons and patients like the new approach because it:
• minimizes the trauma to the patient;
• speeds recovery time;
• shortens the hospital stay;
• reduces scarring; and
• lowers the risk of bleeding and blood loss.

“Minimally-invasive techniques have been used in other surgical procedures for years and are now having a major impact on cardiovascular procedures. The benefits to patients are tremendous” says Dr. Petit.

Dr. Petit performed his first minimally invasive mitral valve surgery in May with excellent results. “It’s very important to offer patients options that achieve the desired results, but are less traumatic,” Dr. Petit explains. “With this new procedure, we haven’t really changed anything integral in the traditional mitral valve surgery, just how we access the problem,” he says.

The minimally invasive procedure is not for everyone. If a patient needs more than just simple repairs to the mitral valve such as bypass surgery or work on the aortic valve, it’s not the best approach.

“Minimally-invasive mitral valve surgery is not yet widely available, but as more surgeons receive training in the technique, we can expect more and more of this type procedure to be performed because of the significant benefits to the patient,” says Dr. Petit.