Minimally Invasive Mitral Valve Repair and Replacement

The mitral valve is a cardiac valve that controls blood flow from the left atrium to the left ventricle and the valve functions to ensure that blood flows in a unidirectional forward flow between these chambers of the heart. The mitral valve can be diseased resulting in either a leaking (mitral regurgitation) or narrowed (mitral stenosis) valve. For patients with severe mitral valve disease, the treatment indicated is surgical valve repair (the preferred choice whenever feasible) or valve replacement. These procedures are conventionally performed via a median sternotomy approach, whereby a longitudinal incision is made across the anterior chest wall.

Since year 2000, an alternative approach called Minimally invasive mitral valve surgery was introduced, utilizing a tiny incision (6-8cm) on the right side of the chest wall working between the rib spaces to access the mitral valve. The view to the heart and mitral valve is enhanced and magnified by incorporating a 5mm telescope and the surgery is guided by this excellent endoscopic view displayed onto a display monitor.

The benefits of this procedure includes less pain, better comfort, faster rehabilitation, less blood transfusions, superior cosmetic result and avoidance of sternal wound complications. Additional advantages include an excellent image of the mitral valve to the surgeon that facilitates complex repair and redo procedures.

Diagram. Conventional Median Sternotomy (left) and Minimally invasive approach via a small lateral thoracotomy (right)

Photos of minimally invasive mitral valve repair. Small incision on the side of the chest wall (left) and the excellent magnified image of the mitral valve viewed from a telescope (right).

Surgical scars from a median sternotomy (left) and from minimally invasive approach (right)

Minimally invasive mitral valve surgery was introduced at IJN in 2009 when we were the first centre in the ASEAN region to perform this surgery. Since then, we have successfully performed a total of 20 procedures which includes 10 valve repairs and 10 valve replacements. The patients experienced less pain and were able to be rehabilitated faster and had a shorter hospital stay.

IJN EXPERIENCE AND TRACK RECORD

The better comfort, faster recovery and excellent cosmetic result also made this a requested procedure by younger patients who wanted a quick return to normal life following surgery. We have further expanded this approach to perform other surgeries which have included minimally invasive tricuspid valve repair, aortic valve replacement and closure of atrial septal defect. Minimally invasive cardiac surgery is performed by a special dedicated multidisciplinary team which includes the cardiothoracic surgeon, anesthesiologist, perfusionist and nurses.