Minimally Invasive Heart Valve Surgery
By K. Fon Huang, M.D.

St. John’s Cardiovascular Surgery program is the region’s leader in case volume, variety and breadth of services offered, and now documented excellent outcomes.  Utilizing the Society of Thoracic Surgeons database for bench marking; in 2007, our heart surgery program had an overall mortality rate of 1.8% compared to the national average of 2.5% representing a 38% better outcome for our patients.  Even more impressive is our mortality for first time CABG, the most common heart operation, was only 1.1% compared to a national average of  2% which is a nearly a 50% improvement.  In addition major complication rates have fallen over the past year from 16% to only 10% and major wound infections to less than 1%. Our caseload or number of heart operations remains in the 90^th percentile nationally as well.

In the past two years, minimally invasive approaches for valve surgery has been growing and maturing at St. John’s hospital.  The goal is to make heart valve surgery less invasive to the patient and promote faster recovery and return to normal physical activities.   Under the expertise of Dr. Fon Huang, techniques have been adopted to reduce the trauma and stress of valve surgery for our patients.  Specialized long shaft instruments are used to work within the smaller openings.  The multiple port incisions and high costs of robotic assisted surgery have not been adopted, yet.  Isolated valve operations can now be done through a single mini-incision that is 1/3 to 1/4 the size of a traditional chest incision and frequently without splitting bone.  Our smallest incision so far is a 2 ¼” incision for an aortic valve replacement.

Even more complex operations such as aortic root enlargement, complex mitral valve repairs and replacements for endocarditis, reoperative valve surgery and double valve surgery have been done with minimally invasive approaches.  Aortic valve replacement for stenosis or insufficiency can be approached through mini-partial sternotomies or mini- anterior thoracotomies.  The minimally invasive thoracotomy approach is particularly suited for mitral valve surgery in that bone splitting is completely eliminated. For reoperations the old breast bone incision and scarring can be avoided.  Successful mitral valve repairs have been achieved in over 90% of appropriate cases.  For the patient, this not only means a smaller, cosmetic scar but faster healing times and return or release to full normal activities in 2-3 weeks rather than 6-8 weeks required for normal bone and muscle healing.  So far approximately 30 patients have benefited from these approaches instead of the standard full open sternotomy.

Mitral Valve Repair

Patients who need mitral valve surgery generally do significantly better with valve repair versus total replacement.  Their postop mortality (death rates) and complications are far less and their recovery faster.  In recent years St John’s surgeons have continued to increase the percentage of mitral valve repairs.  Accounting for all mitral valve operations at St. John’s hospital, in the past three years our valve repair rate has increased from 55% to 76%.  This is more than the STS national average of approximately 60%.  To get a successful valve repair rather than replacement experience counts!  And now these can be done through minimally invasive approaches.  Valve repairs leave less foreign material in your heart.  In addition, patients who have a mitral valve repair instead of replacement do not have to take lifelong blood thinners (Coumadin) eliminating the bleeding and bruising risks and reducing the hassle of frequent blood testing.  The majority of patients with mitral valve regurgitation can be repaired successfully by an experienced surgeon. 

All patients needing isolated heart valve operations are potential candidates for the minimally invasive approaches. To get these benefits, they do not have to travel afar to major metropolitan centers or academic institutions. St. John’s is maturing into a regional referral center where nearly all leading edge cardiovascular surgery services can be offered with excellent outcomes and benefits for your patients.  For further information, questions or patient referrals please contact us at (417) 820-3960. E-mail questions can be sent to kfhuang@sprg.mercy.net