Traditionally, when surgeons repair a leaking mitral valve, a large incision is made down the middle of a patient’s chest to open the breast bone and access the heart. But in many cases, cardiac surgeons at the Washington University and Barnes-Jewish Hospital Heart and Vascular Institute are able to repair those valves using minimally invasive techniques.
“We’ve developed specialized instruments that have simplified it and made it possible to repair mitral valves through a small incision underneath the armpit,” says Ralph Damiano, MD, chief of cardiac surgery at Washington University and Barnes-Jewish. Dr. Damiano is nationally renowned as a pioneer in minimally invasive heart surgery and is one of the most experienced at performing the procedure. While he has been performing the procedure for almost eight years, it is still not widely performed by the majority of cardiac surgeons.
The benefits of the procedure include shorter length of stay in the hospital, less pain, quicker recovery and no scar down the middle of the chest.
(For more information watch this video on minimally invasive mitral valve surgery.)
“For women, we put the incision right under the right breast, and not only is it good from a cosmetic standpoint but there’s quite a bit less pain associated with that,” he says. “We just go right in between the ribs.”
This approach – also called a right mini-thoracotomy — usually means one less day in the hospital and a return to activity in just a couple of weeks – around two to four weeks faster than traditional open surgery. In addition, the procedure brings has a decreased risk of infection.
“We’ve seen a significant decrease in the infection rate because, as you can imagine, if you have a big incision down your front, we’ve found that that tends to get infected about one in 100 times,” says Dr. Damiano. “But the mini-thoracotomy incision that we use, we really don’t see any infection.
“When we’ve compared our minimally invasive cases to our open full sternotomy cases, we’ve also noticed less bleeding and a shorter time on the ventilator, and all that speeds up your recovery.”
According to Dr. Damiano, virtually any patient needing mitral valve repair is a candidate for minimally invasive approach, however because of the smaller incisions, it must be performed perfectly.
“It’s exciting for me to be able to take part in these advances and it’s particularly gratifying to develop strategies to try to decrease the risk of surgery for patients,” says Dr. Damiano.
For more information, call 866-TOP-DOCS (867-3627).