The man sitting across from me had traveled a long way from Saudi Arabia. He needed heart valve surgery. He could have had traditional surgery at home, but he wanted to know if we could fix his valve without the pain of breaking his breastbone. I told him we could – with minimally invasive heart valve surgery.
Unfortunately, way too many people don’t know about minimally invasive heart valve surgery. This is, in part, for two reasons: these procedures are fairly uncommon in most centers, so only a few doctors perform them, and they are highly complex surgeries that are only performed at a handful of centers across the country. This approach is so rare that fewer than 1% of aortic valve surgeries worldwide are performed this way, as well as fewer than 20% of mitral valve surgeries.
At UT Southwestern, minimally invasive heart valve surgeries take less time to complete than the traditional operation, and patients generally have fewer complications and are often fully recovered in as few as 10 days, compared to six to eight weeks after traditional surgery. Because their sternum is not split, pain management after surgery is a lot less complicated. At our center, the average length of stay after surgery is only three days, which means patients can get back to work and resume normal activities that much sooner. Our patients also benefit from much smaller, less noticeable scarring as a result of a 2-inch incision compared to the much larger scar from traditional open surgery.
No Broken Bones
Dr. Doolabh routinely performs aortic valve replacement, mitral valve repair or replacement, tricuspid valve repairs or replacements using a minimally invasive approach, which does not require cutting through any bones.
Click the button below to learn more about his approach and talk directly with a member of Dr. Doolabh’s team.
Not all “minimally invasive” heart valve surgeries are created equal. Some centers say they do these procedures, and while they make a smaller incision than traditional surgery, they still saw through a good portion of the breastbone. This is called a partial sternotomy and it is NOT the approach I use. When I say minimally invasive, I mean we don’t break any bones.
Minimally invasive valve surgery joins the ranks of other advanced heart procedures such as transaortic valve replacement (TAVR) and MitraClip mitral valve repair, which often result in quicker recoveries than traditional open surgeries. However, my approach is a full surgery, not an interventional procedure. Let’s discuss how minimally invasive heart valve surgery works, who is eligible, and what to ask your doctor if you need heart valve surgery.
How does minimally invasive heart valve surgery work?
There are four valves in the heart: the aortic valve, mitral valve, pulmonary valve, and the tricuspid valve. These valves open and close to allow blood to pass through the different chambers of the heart and distribute oxygen-rich blood throughout the body. Malfunction of any of these valves can cause inefficient blood flow.
Three main problems can arise when a valve doesn’t work properly:
- The valve doesn’t close completely, allowing blood to leak back into the heart. This is known as regurgitation.
- The valve doesn’t open fully, which reduces blood flow out of the heart. This is known as stenosis.
- An infection damages or destroys the valve, known as endocarditis.
UT Southwestern is one of a handful of centers in the U.S. where heart valve surgery is performed through a small incision without breaking any bones. Generally, heart valve surgery is performed by splitting the sternum (breast bone) to access the heart, but our surgical approach does not require breaking any bones. Click on the animations below to see how minimally invasive heart valve surgery differs from traditional heart valve surgery.
Is this the same as robotic surgery?
While some centers around the country use a surgical robot to perform mitral valve surgery, my approach is considered traditional surgery. I choose not to use a robot. This means my patients benefit from the same outcomes of traditional surgery, which is supported by decades of research, but they get the added benefit of a minimally invasive approach.
There is no denying robotic surgery has revolutionized many complex procedures, however, when it comes to heart valve surgery the robotic approach requires multiple small incisions (also called ports) and takes longer to complete than a mini-thoracotomy. I have performed more than 3,500 heart valve surgeries during my career, and more than 1,000 of those have taken place at UT Southwestern's William P. Clements Jr. University Hospital.
This means the same intake team, the same OR team, and the same post-surgery recovery team have taken care of my patients more than 1,000 times.
Who is a candidate for minimally invasive heart valve surgery?
Although there are rare cases in which I would recommend traditional surgery, most people are eligible for a minimally invasive surgery.
It’s common for people to hear that they’re too old, sick, or frail to have heart valve surgery. They may not be physically able to handle a long procedure or recovery period. If they have bad knees or hips and rely on their arms to stabilize themselves, it can be even more difficult to allow the breastbone to heal following traditional heart valve surgery.
This is not a problem with the minimally invasive procedure. The surgery is much shorter, which eliminates some potential complications from being under general anesthesia for a long time. And because we don’t divide the breastbone, we don't need to wait for it to heal before my patients return to their normal activities.
Minimally invasive surgery also is preferable for patients who need to return to work to pay the bills. Instead of waiting a month or more, they will be back to work much quicker.
The Heart Valve Hotline
My team works closely to ensure that every patient gets the best experience possible. When you call us, our heart valve team, led by Steva Smartt, R.N., answers the phone 24/7. We stay with you throughout the entire process – from that first phone call to the first visit, and all the way to your discharge. If at any point you have a question, we are always available to you.
Do you see patients from other states?
Actually, we see patients from all over the world! Dallas has two major airports and our hospital is located only two miles from Dallas Love Field Airport. Steva and Nelly – our intake coordinators – work with out-of-town patients all the time. They take care of coordinating benefits, making sure we have the required tests sent over from your providers, and even offer sound technical support because our first appointment is always conducted via telemedicine.
This makes getting a second opinion for out-of-state patients incredibly easy. Since our patients spend an average of only three days after surgery in the hospital, and because pain management is considerably less challenging due to our small incision, our patients are cleared to travel shortly after leaving the hospital.
Because Experience Matters
This procedure is performed by a few surgeons in the U.S. It’s not available at every hospital and not every surgeon can do it. Furthermore, very few centers have the required surgical volume year over year in order to maintain consistent outcomes. This is why I feel bad when I talk with people who’ve had traditional heart valve surgery simply because they didn’t know a minimally invasive option existed.
Commonly, these people were treated in reputable medical centers. They simply didn’t know to ask. I hope that changes soon and everyone who wants minimally invasive heart valve surgery can get it.
If you need a heart valve replaced and you are considering surgery, please be sure to ask your doctor a few simple questions:
- How many minimally invasive surgeries have you performed?
- What are your outcomes?
- Kidney failure rate
- Length of hospital stay
- Stroke rate
- Transfusion rate
If you’re told you need heart valve surgery, ask about minimally invasive options. If your doctor doesn’t offer them, call us for a second opinion. If you end up having surgery, you may have to travel but it will be worth it.
Learn more about Dr. Doolabh’s minimally invasive heart valve surgical procedure.
Come for a second opinion
If you've been told you need heart valve surgery, ask your doctor about minimally invasive surgical options. If he or she doesn't offer any, come to UT Southwestern for a second opinion. You may have to travel, but it will be worth it.