MINIMALLY INVASIVE MITRAL VALVE REPAIR

The heart, our lifeblood, is a fascinating structure that works tirelessly to send blood to every corner of our body. Among its most important components are the heart valves, which are responsible for regulating blood flow.

The mitral valve, located between the left atrium and the left ventricle, plays a crucial role in this system. However, what happens when this valve begins to experience problems, and how can we treat them?

The mitral valve can be affected by various conditions, such as mitral regurgitation or insufficiency, in which the valve allows blood to flow backward, or mitral stenosis, which causes the valve to narrow.

These problems can have a considerable impact on the patient’s health, affecting their quality of life and potentially leading to more serious conditions. Fortunately, advances in current surgery provide effective solutions for these problems. One of these solutions is minimally invasive mitral valve surgery, a modern and effective technique that allows mitral valve disease to be treated without the need for open surgery. This technique involves smaller incisions than those used in conventional surgery, reducing trauma and facilitating a faster recovery.

Minimally invasive mitral valve surgery is so named because of its surgical technique. Instead of a large incision in the chest, which is common in traditional heart surgery techniques, small incisions are made. This approach reduces trauma, minimizes blood loss, decreases the risk of infection, and facilitates a faster and less painful recovery process.

Not all patients with mitral valve disease are candidates for minimally invasive surgery. The suitability of this procedure depends on several factors, including the patient’s overall health, the severity and type of mitral valve disease, and the recommendations of their medical team. Some patients may have conditions that make minimally invasive surgery not the safest or most effective option for them. Preparation for Surgery

Preparation for minimally invasive mitral valve surgery is an essential step before the procedure. This process may include physical examinations, blood tests, and imaging studies such as an echocardiogram. These tests help the medical team better understand the patient’s condition and plan the intervention more accurately. Preparation also involves discussions about the risks and benefits of the procedure, anesthesia, and the postoperative care plan.

The Surgical Process

Minimally invasive mitral valve surgery may involve the use of a camera to visualize and operate inside the heart through small incisions. With this detailed view, the surgeon can manipulate specialized surgical instruments to repair or replace the mitral valve.

Depending on the patient’s situation, the valve may be repaired, preserving the patient’s own valve, or it may be replaced with a prosthesis.

Recovery

Recovery after minimally invasive mitral valve surgery is typically faster than that associated with open surgery.

Patients generally spend a few days in the hospital, where they are carefully monitored by the medical team to detect any early complications.

After discharge, patients may need several weeks to fully recover at home.

Minimally invasive mitral valve surgery is an important advance in the treatment of mitral valve disease; however, like any surgical intervention, it has risks and benefits that must be carefully considered and discussed with the medical team.

Minimally invasive mitral valve surgery may seem like a complicated concept for those facing this decision for the first time. However, with the right information and the support of a trusted medical team, patients can navigate this path with confidence.

This technique may offer a new opportunity to improve health and quality of life, allowing patients to regain control of their cardiovascular health.

 

TAVI (Transcatheter Aortic Valve Implantation) Procedures

Medical advances are continually being made to make surgeries less invasive. In the treatment of aortic valve disease, new techniques are being developed that allow for replacement of the aortic valve with a prosthesis through less invasive procedures for the patient. These procedures shorten hospital stays and accelerate postoperative recovery, thanks to what we know as TAVI (Transcatheter Aortic Valve Implantation).

This procedure involves implanting the aortic valve through catheters, meaning there is no need to open the sternum (sternotomy) or stop the heart, as is done in traditional extracorporeal surgery. It is usually performed on patients at high risk for open surgery, either due to other conditions that could complicate the procedure, advanced age, or a severely calcified aorta.

It requires evaluation by the entire medical team to assess the risks and benefits of each technique and offer the patient the procedure that offers the best long-term results.

The procedure consists of inserting the aortic prosthesis through catheters until it is positioned at the level of the aortic annulus, guided by the X-ray system integrated into the hybrid operating room and complemented by various tests: transesophageal echocardiography, electrocardiogram, etc. There are several methods or approaches for introducing these catheters:

Transfemoral: The prosthesis is introduced by puncturing the femoral artery, which can be accessed through the groin.

Transaxillary: An incision is made below the clavicle to access the axillary artery and insert the valve.

Transapical: In this case, a small thoracotomy (an incision in the chest without having to open the sternum) is made to access the apex of the heart to insert the prosthesis directly into the heart without establishing extracorporeal circulation.

Transaortic: A mini-stereotomy allows access to the aorta and inserts the catheter with the prosthesis.

The prostheses are made of biological material and are surrounded by a stent (spring) that allows them to be anchored in the appropriate position. Once the prosthesis is positioned in the aortic annulus, it is expanded for fixation, its proper function is checked, and the catheters are removed. Considerations to keep in mind.

To decide on the type of procedure to be performed, several diagnostic tests will be performed: echocardiogram, cardiac catheterization, chest-abdominal CT scan with contrast to view the aorta and its main branches, blood tests, etc.

In most cases, the procedure will be performed on the same day of admission. It can be performed under general anesthesia or local anesthesia with sedation. Upon completion, the patient will be transferred to the ICU, where they will remain for the day. If the patient remains stable, they will be transferred to the hospital ward; depending on their progress, they could be discharged 72 hours after the procedure.

In some cases, a blood transfusion may be necessary postoperatively.

 

Complications of Transcatheter Aortic Valve Implantation (TAVI)

-Palpitations. Less common: arrhythmias, need for pacemaker implantation

-Pain at the puncture site or a sensation of heat caused by the catheters and the intravenous injection of contrast.

-Hematoma at the puncture site

-Complication affecting the blood vessel through which the catheter passes (hematoma, dissection, perforation, thrombosis)

-Myocardial infarction, stroke

-Rare: Heart, aorta, or valve rupture requiring conversion to conventional open surgery

 

CARDIAC SURGERY WITHOUT TRANSFUSIONS

Sometimes, transfusions are essential because there is rapid, significant blood loss (multiple trauma, acute hemorrhage, etc.) or because certain diseases or treatments (cancer, blood disorders, etc.) promote chronic anemia. However, in many cases, transfusions have alternatives, and the real cause of the transfusion is the mentality and behavior of the physician and the hospital.

It is possible to perform cardiac surgery without transfusions, but it is not easy. In cardiac surgery, intraoperative and postoperative bleeding is a serious problem that causes between 25% and 80% of patients to receive transfusions. So much so that 15% to 20% of all transfusions in a country’s hospitals are used for cardiac surgery. Performing bloodless cardiac surgery requires a highly qualified and experienced team of professionals, along with a bloodless medicine and surgery program that meets six essential requirements:

  • A comprehensive approach that addresses all the patient’s pathologies and responds to their needs.
  • Cross-process care, beginning when the patient is diagnosed, continuing throughout the hospital stay, and continuing with periodic follow-ups.
  • An effective, highly careful, and highly controlled surgical technique.
  • Multidisciplinary: integrating professionals from diverse specialties (cardiac surgeons, anesthesiologists, intensivists, cardiologists and perfusionists, nursing, care coordination, etc.)
  • Multimodal: applying a wide range of therapeutic measures aimed at avoiding the need for transfusions in the preoperative, intraoperative, and postoperative periods.
  • Individualized. Each patient is different, and a tailored bloodless cardiac surgery protocol must be designed for each patient.

 

What are the results of bloodless cardiac surgery?

Bloodless heart surgery can be performed effectively and safely, even in high-risk patients with complex conditions.

Although many transfusion-avoiding patients have undergone heart surgery in Spain in recent years, it is difficult to find centers or professionals who have developed specific programs for these patients and who routinely perform this type of surgery.

 

MINIMALLY INVASIVE CARDIAC SURGERY

In minimally invasive heart surgery, incisions are made, which are small cuts in the chest. This allows the surgeon to reach the heart by passing between the ribs. The surgeon does not cut the breastbone, as is done in traditional open-heart surgery.

Minimally invasive heart surgery can be used to treat many different heart conditions. Compared to open-heart surgery, this type of surgery typically results in less pain and a faster recovery for many people.

Robotic-assisted heart surgery and thoracoscopic surgery are types of minimally invasive heart surgery.

Many types of heart procedures can be performed with minimally invasive heart surgery. Examples include:

  • Closure of a hole in the heart, such as an atrial septal defect or patent foramen ovale.
  • Surgery for an atrioventricular canal defect.
  • Maze technique for atrial fibrillation.
  • Heart valve repair or replacement.
  • Surgery to remove heart tumors.

The benefits of minimally invasive heart surgery compared to open-heart surgery may include the following:

  • Less blood loss.
  • Lower risk of infection.
  • Less pain.
  • Less time on an endotracheal tube, also known as a ventilator.
  • Less time in the hospital.
  • Faster recovery and return to normal activities.
  • Smaller scars.

Minimally invasive heart surgery is not right for everyone.

The risks of minimally invasive heart surgery are similar to those of open-heart surgery. These symptoms include:

  • Bleeding.
  • Heart attack.
  • Infection.
  • Arrhythmias, which are heart rhythm irregularities.
  • Stroke.
  • Death.

contact