The mitral valve controls the direction and flow of blood through the left chambers of the heart. If the valve becomes too hard (calcified) and too narrow (stenosis), flow will be reduced; if the valve becomes too loose or damaged, flow might travel backwards (regurgitation). Abnormal blood flow will force the heart to work harder, eventually causing heart failure. Symptoms that this is occurring include shortness of breath, palpitations, chest pain, syncope and/or fatigue.
When these symptoms become severe, repair or replacement of the mitral valve will become necessary, which traditionally requires the breastbone to be divided in the middle, or more recently through a minimally invasive approach via small cuts in the right side of the chest.
Professor Yan performs minimally invasive mitral valve surgery via a 3-5 cm minithoracotomy approach. A small 3-6 cm (2-3 inch) long incision is made on the right side of the chest below and away from the nipple. Cardiopulmonary (heart-lung) bypass machine is used via the groin vessels to sustain the blood supply to the rest of the body. Two 1 cm small incisions are also made in the chest, which allow the surgeon to insert special delicate long instruments and a videoscope to access and view the heart.
Once the acess to the valve is obtained, Professor Yang may choose to repair the valve and/or its supporting structures, or replace it with a mechanical or biological valve. Mechanical valves are very durable, but require patients to take a blood-thinning medication, warfarin, for the rest of their lives. Biological valves may only last 7-15 years, but may not require the patient to take blood thinning medications. The pros and cons of each valve will be discussed in details before the operation. For more details, please click here.
Benefits of minimally invasive mitral valve surgery includes:
- Reduced pain
- Reduced blood loss
- Reduced risk of infection
- Faster recovery and shorter hospital stay
- Less scarring and better cosmetic appearance
Some risks associated with this type of surgery remain the same as those for open mitral valve surgery. These include stroke, mortality and risks associated with cardio-pulmonary bypass. Professor Tristan Yan will discuss the potential risks weighed against the benefits with you at the time of your consultation.