About the Procedure
Minimally invasive valve replacement is one of the specialties of the Cardiothoracic Surgery and Interventional Cardiology Center at the VMT Clinic named after N.I. Pirogov, SPbSU. We perform aortic valve, mitral valve, and tricuspid valve replacement surgeries.
Acquired heart valve diseases rank third in frequency after hypertensive and ischemic heart diseases. Isolated lesions of the mitral or aortic valves are diagnosed in more than 70% of patients with heart valve defects. To address this issue, we offer our patients valve replacement surgeries.
Modern knowledge and experience allow us to minimize the size of the chest incision for heart valve replacement surgery (traditional surgical access to the heart was described in previous descriptions of treatment procedures). Such surgeries are called minimally invasive, performed through reduced access. The use of small incisions was proposed in the mid-1990s.
The surgical technique remains the same, but the length of the skin incision is only about 5-7 cm and does not involve complete sternotomy (full midline sternotomy). Despite the technical complexity, the advantages of mini-access in valve surgery seem obvious, both for surgeons and patients. The advantages of minimally invasive valve replacement include better cosmetic results, less pronounced pain syndrome, and early postoperative patient activation due to preservation of the chest wall's structural function and reduced surgical trauma. Cardiothoracic surgeons determine the indications for mini-access based on height-weight parameters and the presence of concomitant pathologies; thus, not every patient is eligible for the described method of surgical correction.
In the High Medical Technologies Clinic, the most commonly used accesses are mini-median sternotomy (mini-J) for aortic valve replacement surgeries and right thoracotomy when it comes to mitral valve replacement and/or antiarrhythmic surgery for atrial fibrillation (left atrial cryoablation, an operation similar to the «Labyrinth» procedure). In the latter case, peripheral extracorporeal circulation is required, making it necessary to perform a second incision in the groin area, 3 cm in length, for cannulation of the femoral vessels and connection to the extracorporeal circulation apparatus.
Over the past two decades, sufficient experience has been accumulated to assert that surgeries using mini-access for mitral, aortic, or tricuspid valve replacement are safe. Their outcomes are comparable to those of traditional interventions and, in the vast majority of cases, reduce the frequency of early postoperative complications, shorten rehabilitation periods, and contribute to the earliest possible return of patients to normal activities.