Surgical Treatment

Our cardiothoracic surgeons work hand-in-hand with our cardiologists, interventional cardiologists and you to provide the most advanced comprehensive care available. They have vast experience specializing in minimally invasive and complex cardiac procedures.

If your valve disease is advanced, it is usually treated by one of two surgical options:

• Valve repair: in many cases, it’s possible to preserve the original valve and leaflets by surgically repairing the defects. When this can be successfully done, it is often the best approach.
• Valve replacement: in some cases, repair of the existing valve isn’t possible, or is unlikely to be effective. In this case, the valve may be replaced with either an organic valve (a pig valve) or an artificial valve.

In many cases, repair and replacement of heart valves may be performed using minimally invasive techniques to avoid thoracotomy or “open-heart” surgery. Traditional surgery is performed by cutting through the breastbone to open the chest, and connecting the patient to a heart-lung bypass machine. Minimally invasive surgery, by contrast, is performed through several small incisions while the heart continues to beat. Instruments may also be introduced through catheters threaded through a vein. Although not all situations are suitable for minimally invasive surgery, when appropriate it offers a number of advantages:

• Reduced risk of infection
• Less trauma to the heart muscle and chest
• Reduced length of hospital stay
• Shorter recovery with less pain

 

Valve-sparing aortic root repair

In this procedure, your surgeon replaces the enlarged section of your aorta with an artificial tube (graft). Your aortic valve remains in place.

 

Minimally invasive aortic valve replacement

In this procedure, your surgeon may make a two to three inch incision in the right part of your chest near the sternum (breastbone). The muscles in the area will be divided and allows your surgeon access to the heart and aortic valve. If your aortic valve is too disease for repair, a new valve will be put in place:

• Mechanical. This is made of man-made materials, such as titanium or carbon. These valves have the best longevity, but you will need to take blood thinners for the rest of your life.
• Biological. This is made of human or animal tissue, typically bovine. These valves can last for 10 to 20 years, but you may not need to take blood thinners for life.

There are many advantages to minimally invasive mitral valve surgery, including:

• Reduced pain, blood loss and risk of infection
• Shorter hospital stay
• Faster recovery and return to work
• Less scarring and improved appearance after surgery

 

Ross procedure or pulmonary autograft

In this procedure, your surgeon will replace your diseased aortic valve with your own pulmonary valve. The pulmonary valve is then replaced with a cadaver pulmonary valve. This procedure may be a good option especially for younger, more active people. The longevity of the pulmonary autograft is greater than a mechanical valve and you don’t have to take blood thinners for life like with a mechanical valve. Also, there are no artificial materials being introduced so there are no issues with rejection. Success rates for this procedure are very high, around 97% and the long-term results have been excellent.

 

Minimally invasive mitral valve repair or replacement

There are several different ways to perform minimally invasive mitral valve surgery.

• Your surgeon may make a two to three inch incision in the right side of your chest near the sternum (breastbone). Muscles in the area will be divided and allows your surgeon access to your heart. A small incision is made in the left side of your heart to repair or replace the mitral valve.
• In an endoscopic procedure, your surgeon will make one to four small holes in your chest. Surgery is performed through the small incisions using a camera and specialized tools.

If your surgeon can repair your mitral valve, you may have:

• Ring annuloplasty. Your surgeon will tighten the valve by sewing a ring of metal, cloth, or tissue around the valve.
• Valve repair. Your surgeon will trim, shape or rebuild one or both of the flaps that open and close your valve.

If your mitral valve is too damaged to repair, you will need a new valve. This is called replacement surgery. Your surgeon may remove some or all of your mitral valve and replace it with one of two options:

• Mechanical. This is made of man-made materials, such as titanium or carbon. These valves have the best longevity, but you will need to take blood thinners for the rest of your life.
• Biological. This is made of human or animal tissue, typically bovine. These valves can last for 10 to 20 years, but you may not need to take blood thinners for life.

There are many advantages to minimally invasive mitral valve surgery, including:

• Reduced pain, blood loss and risk of infection
• Shorter hospital stay
• Faster recovery and return to work
• Less scarring and improved appearance after surgery

 

Minithoracotomy valve replacement

In this procedure, your surgeon will make a two to three inch incision under your breast bone allowing access to your valve. Your surgeon will then replace your diseased valve with one of two options:

• Mechanical. This is made of man-made materials, such as titanium or carbon. These valves have the best longevity, but you will need to take blood thinners for the rest of your life.
• Biological. This is made of human or animal tissue, typically bovine. These valves can last for 10 to 20 years, but you may not need to take blood thinners for life.

There are many advantages using this minimally invasive approach, including:

• No need to break through any bone
• Reduced pain, blood loss and risk of infection
• Shorter hospital stay
• Faster recovery and return to work
• Less scarring and improved appearance after surgery

 

Ministernotomy valve replacement

This utilizes a significantly smaller incision than a full, median sternotomy. If you are having an aortic valve replaced, the incision will be made through an upper ministernotomy, meaning the incision will be made from the sternal notch to the third intercostal space. If you are having a ministernotomy for mitral valve replacement, the incision will be in the lower end of your sternum upward to the second intercostal space and extending into the interspace on the right.

Your surgeon will then replace your diseased valve with one of two options:

• Mechanical. This is made of man-made materials, such as titanium or carbon. These valves have the best longevity, but you will need to take blood thinners for the rest of your life.
• Biological. This is made of human or animal tissue, typically bovine. These valves can last for 10 to 20 years, but you may not need to take blood thinners for life.

 

Concomitant Maze and Valve Surgery

This minimally invasive procedure is performed simultaneously to treat both your valve disease and you’re atrial fibrillation. Click here to learn more about the Maze procedure.

Beyond surgery

Cardiac health support doesn’t end with successful treatment. We know how important aftercare is to recovering your wellbeing and full activity. To help you get the most from your surgery, we offer a full program of aftercare, including access to the St. Helena cardiac rehab program. Through the cardiac rehab program, you can work with specialists in cardiac recovery, healthy lifestyle, and chronic disease management, to craft a personalized plan to help you recover fast, enjoy a full life, and avoid future heart problems.

Getting started

We know that dealing with heart problems can be overwhelming, and navigating the maze of cardiac treatment can be challenging. That’s why we have a dedicated Valve Coordinator to help you through all phases of your cardiac care, connect you with education resources, and coordinate your care with the rest of your health care team. You can reach our Valve Coordinator at (707) 963-6322.