What is minimally-invasive aortic valve replacement surgery?

Written by: Mr Toufan Bahrami
Published: | Updated: 10/12/2018
Edited by: Bronwen Griffiths

A healthy aortic valve opens wide to allow blood to exit the heart into the aorta and closes tightly to prevent blood from flowing back into the heart. Aortic valve disease occurs when the valve is unable to open or close properly. Aortic stenosis is a narrowing of the aortic valve that prevents the valve from opening properly, holding back the flow of blood from the heart's left chamber into the aorta. Aortic regurgitation occurs when the aortic valve does not close properly between heartbeats, allowing blood to regurgitate, or spill back, from the aorta into the left ventricle.

Mr Toufan Bahrami, a top cardiothoracic surgeon and a leader in the field of minimally-invasive aortic valve replacement surgery, explains why the aortic valve malfunctions and how surgery can overcome this problem.

What is the reason for aortic valve replacement surgery?

Aortic valve replacement is the most effective method of treating severe aortic valve disease. The aortic valve may need to be replaced for the following reasons:

  • The valve has become narrowed (aortic stenosis).
  • The opening of the valve has become smaller, obstructing the flow of blood out of the heart.
  • The valve is leaky and allows blood to flow back into the heart.

The problems can get worse over time and in severe cases can lead to life-threatening problems such as heart failure, if left untreated. There are no medicines to treat aortic valve problems, so replacing the valve will be recommended if the patient is at risk of serious complications, but are otherwise well enough to have surgery.

What are the symptoms?

Some people with aortic valve disease may not experience symptoms for many years. Signs and symptoms of aortic valve disease may include:

  • Abnormal heart sound (heart murmur) heard through a stethoscope
  • Shortness of breath, particularly when they have been very active or when they lie down
  • Dizziness
  • Fainting
  • Chest pain or tightness
  • Irregular heartbeat
  • Fatigue after being active or having less ability to be active
  • Swelling of the ankles and feet

What is the procedure for minimally invasive aortic sutureless valve replacement surgery?

The most common minimally invasive techniques are ministernotomy and right anterior minithoracotomy approaches. The minimally invasive techniques for aortic valve replacement can be performed through a small incision either on the side of the chest (muscles in the area will be divided) or only through the upper part of the sternum as opposed to a conventional full sternotomy. This allows the surgeon to reach the heart and aortic valve.

These techniques have proved to be a safe approach for the treatment of aortic valve disease and are associated with a number of additional benefits for patients. These approaches are increasingly being used with the aim of reducing the “invasiveness” of the surgical procedure, while maintaining the same efficacy, quality and safety of a conventional approach. Despite these advantages, this procedure is limited by the longer cardiopulmonary bypass time, which has raised some concerns in fragile and high risk patients. However, with the introduction of sutureless and fast deployment valves, operative times have dramatically reduced by 35-40%, standardising this procedure.

What are the benefits of this procedure?

Advantages of minimally invasive approaches include:

  • Reduced number of complications, such as wound infection.
  • Smaller incisions and improved aesthetic appearance of scars which also facilitate reoperation at a later date as part of the pericardium remains closed.
  • Reduced length of hospital stay and a faster recovery
  • Less pain
  • Reduced need for blood transfusion

 

If you are concerned about your heart's health, make an appointment with a specialist.

By Mr Toufan Bahrami
Cardiothoracic surgery

Mr Toufan Bahrami is a leading senior consultant in cardiac surgery at the forefront of innovations in his field, based in London. He is nationally and internationally renowned for his expertise in various types of minimally-invasive and endoscopic keyhole cardiac procedures, including mitral, aortic, root and CABG surgeries as well as his wealth of experience in heart and lung transplantations and mechanical circulatory support and reoperation for complex heart operations.

Mr Bahrami trained and qualified as a doctor at Paris’ Pitié-Salpêtrière University Hospital, winning the first place in the French national examination for medical specialisation, le concour d’internat. He worked with Professor Alain Carpentier (pioneer of the technique of mitral valve repair).

He then relocated to the UK to undergo further training and went on to work as a consultant in cardiac surgery at the Hammersmith Hospital, St Bartholomew's Hospital and the London Chest Hospital. Since 2001, Mr Bahrami has been based at the Harefield Hospital where he worked with Sir Professor Magdi Yacoub and then pioneered and led the minimally-invasive and endoscopic cardiac surgery program, including mitral valve repair surgery since 2010. Additionally, he is an honorary consultant at four other NHS hospitals in Surrey, Buckinghamshire and Bedfordshire.

Mr Bahrami has been at the forefront of developments in endoscopic minimally invasive heart surgery and mitral valve repair for many years. He was the first surgeon in the UK to perform endoscopic vein harvesting surgery and mini thoracotomy aortic valve replacement. He was also the first surgeon worldwide to perform a minimally-invasive artificial heart implantation in 2009, and, multiple valve surgery that is endoscopically assisted as well as coronary artery bypass grafts (CABG) through minimal access. He also pioneered and regularly performs CABG through a mini incision on the left side of the chest whilst the heart is beating (MIDCAB).

Having performed over 4000 procedures, of which over 1500 are minimally-invasive cardiac surgeries over the past twenty two years, Mr Bahrami is regarded as one of the UK’s leading cardiac surgeons. He regularly takes on high risk and complex cases, with excellent outcomes for patients. Mr Bahrami is passionate about offering highly-personalised care tailored to each patient’s needs. Each case is thoroughly reviewed by himself and his multi-disciplinary team in order to achieve the best possible outcomes for patients. This approach, combined with his wealth of experience and knowledge of state-the-art surgical techniques make him a leading expert in his field.

Mr Bahrami has published numerous research papers in peer-reviewed journals on topics in his field such as valve repair and transplantation. He is actively involved in several research projects, including the pioneering harpoon beating heart mitral valve repair device. He organises regular training courses in Geneva for cardiac consultants about his areas of expertise.

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