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Minimally Invasive Valve Repair a Cut Above Traditional Surgery

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Posted: 1/10/2006

COLUMBUS, Ohio – Surgeons at The Ohio State University Medical Center are reducing discomfort and speeding recovery times for patients who require a mitral valve repair by routinely performing the repairs using minimally invasive techniques.

The minimally invasive approach requires a smaller incision than traditional open-heart surgery, reducing trauma to the patient and particularly easing post-operative breathing, according to Dr. John Sirak, a cardiothoracic surgeon at the Richard M. Ross Heart Hospital at Ohio State University.

“Everything is done through a 2 1/2-inch incision and only half of the breastbone is divided. The lower half of the sternum remains closed,” Sirak said.

For traditional open-heart surgery, a 10- to 12-inch incision is required and the entire sternal bone is separated to gain access to the heart.

“Because anyone who has chest surgery is at risk for pneumonia or pulmonary problems, there’s no question that leaving half the sternum intact makes it much easier for patients to clear their secretions more effectively after the operation. Their discomfort is lessened, and they often leave the hospital sooner,” Sirak said.

The refinement of the minimally invasive valve surgery accompanies a trend toward repairing, rather than replacing, just about any damaged mitral valve, Sirak added. Approximately 90 percent of damaged mitral valves can – and should – be repaired rather than replaced, he said.

Typically, only valves calcified because of rheumatic disease require a mechanical or donor tissue replacement, he added.

The mitral valve separates the left ventricle from the left atrium. The damage to the valve, resulting in leakage of blood back into the atrium, can be caused by a number of factors, including congenital defects, high blood pressure or chronic heart conditions. Some symptoms of mitral valve problems include shortness of breath, decreasing exercise tolerance, fatigue and pneumonia.

Sirak said physicians consider repair the standard of care for mitral valve problems because a replacement requires removal of the actual valve structure, which can eventually lead to a weakening of the left ventricle’s performance.

“Patients actually do better with a repair rather than a replacement. They live longer and feel better,” he said. “I’ve taken patients who are frail and elderly through this procedure and seen them through their hospitalization. I’m absolutely convinced these patients do better.”

The strategy varies according to each individual case, but Sirak said in general, repairs allow for the existing tissue to remain intact or minimal removal of diseased tissue. In all cases, a plastic ring is placed around the structure to reinforce the repair and prevent future leaks.

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Emily Caldwell
Medical Center Communications
614.293.3737
emily.caldwell@osumc.edu

Heart Disease; OSU Medical Center; Ross Heart Hospital