Mini Valve Surgery at Stony Brook University Hospital

In open surgery, your surgeon makes an incision down the middle of your chest. For mini valve, your surgeon makes small incisions in your side.
Image courtesy of CardioVations

Mini valve surgery refers to aortic or mitral valve surgery that is performed through a 2- to 3-inch incision between the ribs, called a mini-thoracotomy, instead of a much larger incision in the center of the chest. This minimally invasive technique results in less trauma and risk of infection as well as faster recovery. Mini valve is appropriate for patients who do not have accompanying coronary disease (narrowed or blocked heart arteries). Research shows that mini valve surgery is equally safe and effective as conventional surgery, and is often more comfortable for the patient.

Heart valves are one-way gates that keep blood flowing in the correct direction as it passes between the atria (the heart's upper two chambers) and the ventricles (the heart's lower two chambers). Each of the heart's four valves has a leaflet, or flap, that guides blood flow. Sometimes these valves do not regulate blood flow properly and require surgical repair or replacement. Your surgeon may consider aortic valve replacement when an aortic valve is narrowed (called stenosis) and preventing blood from flowing through the opening correctly or when the valve does not close properly between heartbeats, which allows blood to "spill back" or leak from the aorta into the ventricle (called regurgitation or insufficiency).

How to Prepare

It is important to follow your surgeon's specific instructions in the days and weeks prior to surgery, as they will help ensure a smooth and successful experience. Inform him or her about all medications, herbs, and supplements you take, any allergies, and your history with anesthesia (if you ever had a bad reaction). You may be advised to cut down on alcohol if you drink, stop smoking, avoid certain foods, and fill out paperwork. If you have not visited the dentist in a while, ask your doctor if you should go before valve surgery; there is a possibility that bacteria stemming from dental work can settle around the new valve and cause infection.

Do not eat or drink anything after midnight on the night before your surgery. If you need to take medication, please take it with only a small sip of water. Your physician will instruct you if you need to stop taking any medications.

Before your surgery, you may have a series of imaging tests to get a clear view of your heart and any abnormalities. You may also have an echocardiogram or electrocardiogram.

What to Expect

Prior to your surgery, you and your physician will discuss the type of valve to use. Your surgeon may use a mechanical valve, made of a carbon-based material and a cloth ring, or a tissue valve, made from a pig heart valve or from a tissue that surrounds a cow's heart sewn to a cloth ring. A mechanical valve is permanent, but clots can develop on them, which means you will have to take blood-thinning medication every day. Tissue valves, on the other hand, may need to be replaced on average in about 15 years, requiring another procedure, but they are less likely to form clots and blood thinners may only be necessary for a few months following the surgery.

On the morning of your procedure, you will meet with the anesthesiologist, who will administer the medicine that prevents pain and puts you to sleep during surgery. Your surgeon will make a small incision between your ribs. You will then be attached to the heart-lung machine, which stops the heart temporarily and keeps oxygen-rich blood flowing through your body. Using special instruments inserted through the small incision, your surgeon will make an incision in the heart to access the valve, remove or repair the damaged valve, and stitch a replacement into place as required. Once your surgeon has completed the procedure, he or she will close the heart incision. Your heart is then allowed to resume beating and is disconnected from the heart-lung machine. The incision is then closed. The entire procedure may take up to 5 hours.

Possible Complications

There is a small risk of complications from this procedure that includes (but is not limited to):

• Infection;
• Bleeding;
• Heart Failure;
• Breathing problems;
• Blood clots; and
• Stroke or brain damage.

Recovery

Because of the minimally invasive nature of mini valve surgery, recovery is generally quick and you may often go home within 3 to 4 days. You will likely have your first follow-up appointment within a couple of weeks of hospital discharge. Please follow your physician's instructions and let us know if you have any questions or concerns.