Endoscopic mitral valve repair or replacement

Endoscopic Mitral Valve Repair/Replacement

The new approach, is a minimally invasive procedure, otherwise known as Endoscopic mitral valve surgery. This involves a 1-inch scar in the groin and a further 2 inch scar on the right chest. Four more small (1cm or less) incisions are made around the right breast area.

Patients are selected for this approach with a preoperative CT scan that gives us intricate details inside the body that makes this approach safe.

The minimally invasive endoscopic procedure has been shown to get patients back to a normal quality of life quicker with better cosmetic results. The procedure can also be used to repair the tricuspid valve, which controls blood flow between the right atrium and right ventricle, and to treat people with atrial fibrillation.

It is also effective for repairing holes in the heart and removing tumors in the atrium. A proportion of patients may need more than one procedure, and this can be done using an endoscope.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes between three and four hours.

The surgeon uses 3-4 small incisions in the chest, and a high-definition 3D camera is then used to guide the procedure inside the heart and the surgeon can then repair or replace the damaged mitral valve.

An incision in the groin is made to use the artery and vein in the groin to put the patient onto the bypass machine. Once inside the heart, the repair or replacement technique is carried out in exactly the same way as the sternotomy operation but using endoscopic instruments.

The proven benefits of this minimally invasive procedure are:

• Much quicker recovery period.  Usually after about three weeks the patient will feel better and be able to undertake most of their normal activities
• There will be less post-operative discomfort and pain after a few days.
• Hospital stay will be shorter usually 3-4 days
• Less risk of wound infection and blood transfusion.
• Patient can drive after four weeks if feeling well enough to do so
• Restrictions relating to lifting and pushing up from a bed or chair do not apply with patients who have not had a sternotomy wound
• Cosmetic result is generally excellent.  Particularly in females where the scarring is hidden under the right breast

The consultant will explain the procedure step by step, answering every question you might have.

What are the risks of the surgery?

The two types of surgeries are generally successful as with every surgery, complications can always arise.

The mitral valve replacement surgery has a higher risk of life-threatening problems than mitral valve repair surgery.

Any surgery carries certain risks such as pain, bleeding, blood clots, blood loss, breathing problems, infection, allergic reactions to the medicines

Specific risks of endoscopic mitral surgery could be:

• Conversion in 2% of patients to a sternotomy
• Stroke (less than 1%)
• Infection in the groin wound (less than 2%)
• Heart attack (less than 2%)
• Death (less than half the predicted EuroSCORE)

How soon will I recover?

After the operation you will be transferred to the cardiac intensive-care unit or high-dependency unit, usually for 24 hours, and then to the ward.

You should be able to go home after three to four days.

It can take the patient an average of 3-4 weeks to recover from this type of operation, and they are normally able to drive within 4 weeks.

Your surgeon, physiotherapist and occupational therapist will discuss your individual case with you and offer personal advice as to when you can return to normal activities.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, you should ask a member of the healthcare team or your GP for advice.

Most people make a good recovery, with no more breathlessness or chest pain. You may have more energy after you recover.