The Doctor Is In

Small incisions, big rewards

by James L. Zellner, MD

Only a few years ago, repairing or replacing a damaged heart valve usually required a sternotomy. To get to the heart valve, heart surgeons had to make a 10 or 12-inch incision down the center of the chest cavity and divide the breastbone, or sternum.

Then minimally invasive techniques came into the picture. This new approach to a standard operation is now available at Erlanger – and it’s making recovery much easier for some heart valve surgery patients.

This new approach only requires small incisions through the right side of the chest wall, instead of a large incision through the breastbone. The procedure uses tiny surgical instruments that involve less cutting, reduced blood loss, and a shorter hospital stay than traditional surgery.

Mitral valve The mitral valve controls the flow of blood between the two chambers on the left side of the heart. It allows blood to flow from the left atrium (the upper, blood-holding chamber) to the left ventricle (the lower, pumping chamber). When the valve flaps don’t fit just right or become enlarged, they can’t open or close completely. Blood may leak backward through the valve, which may cause shortness of breath, heart palpitations, chest pains, and other symptoms.

Many people with a mitral valve problem never have symptoms and may not need surgical treatment. Others experience worsening shortness of breath and a deteriorating quality of life. Statistics show that women in particular are developing this problem at a younger age than most other heart diseases.

Treatment options For many people, medications can relieve symptoms caused by valve problems. Others may need surgery to repair or replace the mitral valve. Many of these individuals may be candidates for the minimally invasive procedure.

Repairor replace? If possible, mitral valve repair is preferred over replacement. Repairing the valve is less likely to weaken the heart.

If repair isn’t an option, the mitral valve may need to be replaced with one of two types of substitute valves: mechanical or biological. Mechanical valves are made of man-made materials, while biological valves are taken from cows or pigs, or made from human tissue. Patients with mechanical valves must take blood-thinning medications for the rest of their lives.

Back in action Not everyone is a suitable candidate for minimally invasive heart valve surgery, such as people with hardening of the arteries or morbid obesity. But more and more people are benefiting from these remarkable advancements in medical technology.

In fact, minimally invasive valve replacement is nearly as safe for older patients as younger ones. Limited blood loss during surgery, fewer side effects from small incisions, and shorter hospital stays make recovery faster and much easier than traditional open-heart surgery.

James L. Zellner, MD, is a cardio-thoracic surgeon with the Alliance of Cardiac, Thoracic and Vascular Surgeons. He is also a Clinical Assistant Professor of Surgery with the UT College of Medicine Chattanooga. For more information, call Erlanger’s physician referral line at 423-778-LINK(5465).