True minimally invasive procedure at UTSW
UT Southwestern’s Neelan Doolabh, M.D., has a unique approach to minimally invasive heart valve surgery that is drastically reducing recovery times, improving outcomes, and extending surgical treatment to patients with complex health conditions.
The majority of heart valve surgeries are long and physically demanding for the patient. Surgery can easily last between four and six hours, and, when done the traditional way, which requires dividing the sternum, six weeks of recovery are needed for the sternum to heal. And most centers that perform minimally invasive surgery, even as they utilize a small or “mini” incision, still divide one-half to three-quarters of the sternum, which likewise requires time for the bone to heal.
But it doesn’t have to be this way.
Dr. Doolabh, Associate Professor of Cardiovascular and Thoracic Surgery and Director of Minimally Invasive Heart Valve Surgery, is one of an elite group of surgeons worldwide who performs heart valve surgery without breaking any bones. The procedure he uses, while technically demanding for a surgeon to perform, takes only about two hours.
For a procedure like aortic valve surgery, Dr. Doolabh accesses the thoracic cavity by going between the ribs, making a small incision of two inches or less, as compared to the 10-12 inch incision over the sternum used in traditional surgery.
“The vast majority of so-called ‘minimally invasive’ heart valve surgeries still involve cutting about half the length of the breastbone even with a smaller incision,” Dr. Doolabh notes. “However, because I enter through the ribs, I’m able to avoid the breastbone altogether.”
Some physicians perform this procedure with a surgical robot, which, while also avoiding breastbone cutting, necessitates multiple incisions and a longer surgery. Dr. Doolabh does not take that route. Ultimately, he argues, “A robot just cannot do what a human can do in a surgical setting.”
Reduced recovery times
Only about one percent of valve procedures are done the way Dr. Doolabh performs them, but his results speak for themselves. “There is less risk of complications and no six- to eight-week recovery period waiting for the breastbone to heal,” he says. “We let our patients drive much sooner, and they usually have full mobility within 10 days. And because the surgery is shorter, it also carries fewer risks than traditional approaches that keep patients under anesthesia with their hearts stopped far longer.”
Operating with complex health conditions
This procedure also makes heart surgery a viable option for people who otherwise could not withstand it. For example, patients with complex health conditions or those who might be considered too old or obese for other techniques might be prime candidates for Dr. Doolabh’s approach. Because such patients are not as resilient, they often put off surgery as long as possible, increasing their odds of developing heart failure.
“We’ve seen that cardiologists are referring patients to me sooner instead of putting it off because they know their patient is going to get a simpler operation,” Dr. Doolabh says.
Achieving better outcomes
Dr. Doolabh has performed close to 2,000 minimally invasive valve surgeries, making him the busiest valve surgeon in Texas. The Society of Thoracic Surgeons has recognized him as being in the top 3 percent of surgeons in terms of patient outcomes data, including very low rates of complications such as stroke and kidney failure, short hospital stays, and low rates of hospital readmission.
“Dr. Doolabh’s expertise in minimally invasive heart valve surgery is a valuable asset to the North Texas community,” says Michael Jessen, M.D., Chair of the Department of Cardiovascular and Thoracic Surgery. “His dedication ensures patients get compassionate, effective care, while his skill and technique make heart surgery more viable for people with complex health conditions, for whom traditional heart surgery poses greater risks.”
For more information or to refer a patient, visit Dr. Doolabh's physician profile or call 214-74-VALVE. Calls are answered 24/7 by a registered nurse.