Clinician-to-Clinician Update Clinician-to-Clinician Update

Less-Invasive Mitral Valve Surgery Matches Outcomes, Speeds Recovery

November 2015

Recent advances in surgical techniques and endoscopic technology now allow many patients with mitral valve disease to opt for minimally invasive surgery instead of the traditional sternotomy. In the United States, approximately 6.5% of the population has some type of mitral valve disease, which includes mitral valve stenosis, regurgitation, or prolapse.1 For patients who require surgical intervention, valve repair or replacement has traditionally been conducted via sternotomy. The minimally invasive surgical approach, however, has been shown to produce similar outcomes as well as provide for a faster recovery and improved patient satisfaction.

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— Heart specialists in the University of Minnesota Medical Center hybrid operating room. Minimally invasive heart valve repairs and replacements are among the procedures performed in the multifunctional endoscopy-operating suite.

With minimally invasive mitral valve surgery (MIMVS), the heart is approached between the ribs via a 2- to 3-inch skin incision on the right side of the chest. MIMVS requires no sternal incision or spreading of the ribs. The surgeon inserts fine, long-tipped surgical instruments and an endoscope through the incision to perform the procedure.

Reported outcomes with MIMVS have been excellent. Studies have found no differences in morbidity or long-term survival rates between MIMVS patients and those who underwent sternotomy, as well as a similar freedom from reoperation.2,3

MIMVS also provides other measurable benefits for patients, including:

  • Decreased postoperative pain;4
  • Decreased total length of stay in the hospital: 4-8 days versus 6-10 days with sternotomy;1,2
  • Faster physical rehabilitation and return to work and life activities: 3-4 weeks versus 6-8 weeks with sternotomy;3
  • Reduced cost, with an average savings, when compared with sternotomy, of about $8,000 to $9,000;1,2
  • Reduced scarring and improved cosmetic appearance of the chest;3
  • Improved patient satisfaction.3
  • University of Minnesota Heart Care surgeons perform over 50 MIMVS per year, putting Heart Care facilities among the top 10 centers in the United States for surgical volume. Patients of Heart Care specialists have a surgical mortality rate of less than 1% and a rate of postsurgical infections that is close to zero. University of Minnesota Heart Care specialists can manage the most complex cases, including patients who have undergone a prior open heart surgery (see Case Study, page 3) or those with “hostile,” or radiation exposed, chest. They specialize in providing individualized care for every patient.

    References

    1. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006 Sep 16. 368(9540):1005-1011.

    2. Iribarne A, Easterwood R, Russo MJ, et al. A minimally invasive approach is more cost-effective than a traditional sternotomy approach for mitral valve surgery. J Thorac Cardiovasc Surg. 2011;142:1507-1514.

    3. Santana O, Larrauri-Reyes M, Zamora C, et al. Valve surgery more costeffective than median sternotomy? Interact Cardiovasc Thorac Surg. 2015 Oct 3.

    4. Lucà F, van Garsse L, Rao CM, et al. Minimally invasive mitral valve surgery: a systematic review. Minim Invasive Surg. 2013;2013:179569.

    When to refer

    We have locations in Minneapolis and Edina to better serve patients with mitral valve disease. Referrals can be made to either location by contacting 612-365-5000 or toll free 877-650-1555.

    University of Minnesota Heart Care physicians strive to ensure prompt management of all patients and to provide timely responses to our referring physicians and healthcare professional colleagues. We will work with your patient to complete the registration process and to schedule an appointment at the patient’s convenience. You will be notified once the appointment is scheduled.

    Patients with urgent medical or surgical needs are given priority in the appointment system. Appointments for nonurgent medical problems are scheduled several days to several weeks after the request for an appointment.

    Collaborative Care

    University of Minnesota Heart Care providers are proud to offer each patient an individualized approach to cardiac care. This is made possible through a seamless collaboration between all of our cardiac specialists, both surgical and nonsurgical. When you refer your patient to our multidisciplinary program, we are committed to partnering closely with you to obtain the best possible patient outcome through a tailored treatment plan. We value our relationship with you, your patients, and your office staff. We work hard to keep you informed of your patients’ care by providing detailed reports, from diagnosis to treatment and follow-up. Our goal is to provide you with prompt service and communication about the patients that you refer to us.

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