Minimally Invasive Mitral Valve Repair
Minimally-invasive mitral valve repair is an alternative kind of mitral valve repair that does not require a large incision, known as a median sternotomy. It is instead performed with one smaller incision, most commonly an anterolateral mini-thoracotomy on the right side of the chest, with two smaller access incisions to allow tools to access the heart.
Depending on whether the surgery is endoscopic, a camera may be inserted to guide the surgeon to the mitral valve, where the repair takes place. It mainly involves the insertion of a ring around the valve (annuloplasty) to counteract problems due to stretching, the surgical removal of loose segments of valve "leaflets", the suturing of leaflet components, or the attachment of artificial cords to the leaflets to re-establish control of the valve's action.
Mitral valve repair is performed on patients whose mitral valves are damaged, but not severely enough to require replacement. Sometimes people are born with a defective mitral valve, a condition known as congenital mitral regurgitation, but they can also develop in adulthood.
Possible reasons for a mitral heart valve to become regurgitant or stenotic are degeneration, bacterial endocarditis and rheumatic fever. However, the majority of cases are due to degenerative valve disease, where over time the "leaflets" of the valve can become weakened or the chordal apparatus of "heart-strings" lose their ability to control the valve's action.
Minimally-invasive mitral valve repair leads to quicker recovery, better cosmesis, reduced hospital stay, and may result in fewer post-operative complications than conventional mitral valve repair.
Not all cases requiring mitral valve repair may be suitable to be operated on using minimally-invasive techniques. During the operation, there is a very small chance that the surgeon may decide to perform a conventional median sternotomy should there be any unforeseen circumstances.
The recovery time for minimally-invasive mitral valve repair is faster than that of conventional mitral valve repair, usually around 2-3 weeks, and results in less discomfort for the patient. There are less risks of issues with bleeding and infection compared with conventional surgery.
Outcomes for this surgery are as good as the more invasive mitral valve repair.There are less restrictions on heavy lifting after the operation compared to conventional surgery, and the operation results in a shorter hospital stay of around 4 days.
The mortality risk of the operation is less than 1%, with only minor risks of any complications. Over 90% of patients show excellent results, with either trace or no regurgitation post-operation and have no need for further surgery for at least a decade.