The heart has four valves: the tricuspid, pulmonary, mitral and aortic valves. To keep blood flowing in the correct direction, these valves have tissue flaps (leaflets or cusps) that open and close during each heartbeat. In heart valve disease, one or more of the valves in the heart does not function properly. This can disrupt the blood flow through the heart to the  body. Two of the most prevalent forms of heart valve diseases are degenerative valve disease and rheumatic heart disease. Other common heart valve conditions are congenital valve disease present at birth and heart valve infection (endocarditis). Among four valves, the mitral valve is the most frequently affected one. The mitral valve is a valve that allows blood flow from the left atrium to another chamber called the left ventricle. The mitral valve can develop malfunctions which often include regurgitation (the valve does not close completely, causing blood to flow backward instead of forward through the valve) and stenosis (the valve does not open properly or becomes narrow, inhibiting the blood flow out of the chamber). When the mitral valve fails to open and/or close properly, the heart can become damaged, leading to heart failure. Heart valve disease treatment depends upon the affected valve, type and severity of the valve disease. To repair mitral valve, a minimally invasive surgery is considered an effective treatment option, especially if  only few valves are impaired or the disease severity is graded to mild or moderate, without other complications and patients do not have certain underlying conditions. Instead of having a large incision on the chest to cut the sternum  (breastbone being cracked open) required for open heart surgery, mitral valve repair procedure is conducted through smaller incisions. This minimally invasive approach results in less pain, less blood loss and less postoperative complications e.g. lowered infection rates, allowing faster recovery and a quick return to daily life and activities. 
 

Minimally Invasive Surgery: Mitral Valve Repair

Recently, a minimally invasive approach for mitral valve repair has been developed centered upon accessing the valve through much smaller incisions without cutting the breastbone. Mitral valve repair can be performed through 4 small incisions (sized 4-5 cm.) on the right side of the chest. These minimally invasive operation is performed with the use of specialized hand-held instruments and camera that clearly visualizes the damaged valve on the monitor with high-definition. While performing the procedure to repair the damaged valve, the vessel in the groin is connected to a cardiopulmonary bypass machine (heart-lung machine) which is  temporarily used to take over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient’s body. This procedure usually takes 3-4 hours. Due to smaller incisions, superior benefits over open heart surgery include less blood loss and reduced chance of wound infections. Without breastbone cut, patients have a quicker recovery with shorter hospital stay which enables the patients to quickly return to their lives. Although it is an effective treatment to repair diseased valves, mitral valve repair should be performed by well-trained and highly experienced cardiothoracic surgeons in order to ensure the maximum level of safety and the best possible treatment outcomes.
 

Prior to surgery

Before making a treatment plan for individual patient, the cardiothoracic surgeon thoroughly evaluates patient’s symptoms and conducts a comprehensive physical examination. Echocardiography using high frequency sound waves is deployed to assess the structure of the heart, the heart valves and the blood flow through the heart. An echocardiography helps detecting the damaged heart valve and guide the treatment plan. Whether a minimally invasive mitral valve repair is applicable, the medical consideration is determined depending on patient’s age, heath status, underlying diseases and pre-existing conditions as well as the affected valve (s) and its severity. In case the patient is not considered an appropriate candidate for conventional valve replacement, a minimally invasive mitral valve repair can be an alternative option to treat valve disease and restore patient’s quality of life.

Potential advantages of mitral valve repair

There is mounting evidence to suggest that, compared to standard open heart surgery, a minimally invasive mitral valve repair has superior benefits, including:

• No breastbone (sternum) cut
• Smaller incision
• Less pain
• Less blood loss
• Reduced risk of infections
• Faster recovery and shorter hospital stay
• A quick return to daily life and activities
• Better cosmetic result

Even though a minimally invasive mitral valve repair is regarded as an effective treatment approach, it might not be recommended in patients with certain conditions. In such a case, other appropriate surgical procedure will be primarily advised by expert cardiothoracic surgeons. Bangkok Heart Hospital is the pioneer in the development of minimally invasive techniques for mitral valve repair. By using patient-centric approach supported by cutting-edge technology and multidisciplinary team working collaboratively around-the-clock, patients can rest assured that they receive appropriate treatments with the best possible outcomes at all times while their quality of life is taken into major consideration.