Minimally Invasive Heart Valve Surgery

The human heart has four chambers and four valves. The right and left atria are the two chambers at the top of the heart, and the two bottom chambers are called ventricles. Essentially, the heart functions as a muscular pump in which the atria receive blood from the different parts of the body, and the ventricles pump blood back to all the tissues of the body. The valves are responsible for maintaining the unidirectional blood flow between the different sections of the heart.

Changes in the structure of the heart tissue can disrupt blood flow and lead to valvular heart disease. Diseases of the valves are categorized into two types:

• Valve failure: when it does not close to the end and allows a backflow of the blood; this is also known as a “leaky valve”
• Stenosis: when it does not open to the end and obstructs the healthy flow of blood

Life-threatening heart failure can develop as a result of these valve diseases. Fortunately, the early detection of a valve disorder enables treatment, such as minimally invasive valve surgery that can prevent heart failure and death.

In all types of minimally invasive valve surgeries, cardiac surgeons access the heart through small incisions made between the ribs on the right side of your chest. A small endoscope and specialized surgical instruments are inserted into these incisions, and the surgeon is guided by a magnified, high definition video image projected on a nearby monitor. At Sheba, we use a state-of-the-art 3D camera, which gives the surgeon a sharper view of the valve – leading to a shorter operating time and a more effective repair.

The entire procedure, which takes about two to three hours, is done through a minuscule opening (Heartport Access), thereby eliminating the need for a full thoracic opening. As a result, the surgery is associated with less pain and trauma to the body. The risk of complications is greatly reduced, and the size of the scar is minimized.

During the valve surgery, the patient must be connected to a heart-lung bypass machine, which keeps blood flowing through the body during the procedure. In minimally invasive valve surgery, the tubes of the heart-lung machine are inserted through a blood vessel in the groin, with the aid of a 2-inch incision.

After the procedure, you must spend a day or more in the intensive care unit (ICU), receiving fluids, medication, and nutrition through an intravenous line. The total amount of time that you need to stay in the hospital is three to four days on average, depending on your individual condition.

Your Sheba team will monitor your condition and watch for any signs of infection in the incision sites. We will help to manage any postoperative pain that you may experience. After you are discharged from the hospital, you will need regular follow-up exams and testing. Your doctor may also recommend cardiac rehabilitation to help you strengthen your heart. In most cases, the outcome of minimally invasive valve surgery is excellent, and patients report significant improvements in their overall health.

Not every patient is a candidate for minimally invasive valve surgery. Sheba’s doctors will meet with you and review your case to determine whether this procedure is a suitable option to treat your condition. The decision is highly individual, depending largely on the judgment of our experienced cardiac surgeons.

Complications are extremely rare and similar to those associated with all types of surgery, such as bleeding and infection of the surgical wounds. However, as a result of weakness, low blood pressure, and/or new medication, we caution all patients about an increased risk of falls.

In order to help prevent infections, lung ventilation is essential. You may therefore be instructed to practice breathing exercises and respiratory physical therapy under the guidance of our nursing staff. In addition, a dietitian will provide guidelines about what to eat (generally, soft foods) in the days immediately following the surgery, in order to prevent nausea and not overwhelm the stomach.