Minimally Invasive Aortic Valve Replacement

Minimally invasive aortic valve replacement is an option for patients with aortic stenosis or aortic regurgitation. This surgery can help improve symptoms and make you more comfortable.

This surgery can be complicated, and there are risks involved. You and your doctor will decide if it is right for you.

Costs

Minimally invasive aortic valve replacement, also known as MI-AVR, is performed through a small incision without breaking any bones. UT Southwestern is one of a few centers in the country where heart valve surgery is routinely performed this way.

This procedure is quicker and does not increase complications or length of hospital stay. It also results in a lower mortality rate than conventional surgical aortic valve replacement.

However, there is no consensus on the cost-effectiveness of minimally invasive aortic valve replacement over conventional surgical aortic valve replacement. Some studies report lower total hospital costs for minimally invasive surgery, while others report higher hospital costs.

In this study, 324 patients were randomized to receive MI-AVR or C-AVR and were compared in terms of overall outcomes and costs. The results showed that the MI-AVR group had a lower rate of complications and shorter hospital stays, while fewer blood product transfusions were required. In addition, this procedure resulted in a 5% reduction in total hospital costs compared to the C-AVR group.

Preparation

During surgery, your doctor will replace your aortic valve. This may be done if your aortic valve isn’t working properly, or if you have aortic stenosis or aortic regurgitation.

Aortic stenosis means that your valve can’t open fully, so blood leaks back into your heart. Aortic regurgitation is when your valve leaks too much, so some blood comes back to your heart instead of going out to the rest of your body.

Your doctor will discuss with you what kind of valve replacement is right for you. You can have a mechanical or a biological (tissue) valve.

Biological valves are made from pig, cow, or human heart tissue. They don’t last as long as mechanical valves, but they have less risk of blood clots and infections.

Surgery

Minimally invasive aortic valve replacement surgery can be more cost-effective than conventional open heart surgery. It also requires less time in the hospital and lowers complication rates, according to a study published in Circulation Journal.

During minimally invasive aortic valve surgery, surgeons use small incisions through your breastbone or between the ribs on your side to access your heart. The surgery is performed under general anesthesia.

After the procedure, you’ll spend 3 to 7 days in the hospital. Nurses will monitor your condition at all times. You may have two or three tubes in your chest to drain fluid from around your heart, which are usually removed 1 to 3 days after surgery.

During recovery, you’ll need to take medications and limit physical activity. You can also begin a cardiac rehab program to make your heart and body stronger. It can help you feel more confident about your recovery and return to daily activities. But it’s important to avoid heavy lifting and exercises that require a lot of physical strain.

Recovery

Minimally invasive aortic valve replacement (MIAVR) has emerged as a safe, well-tolerated and efficient treatment option for aortic valve disease. The procedure offers significant advantages including reduced postoperative morbidity, a shorter intensive care unit (ICU) stay, shortened hospital length of stay and better cosmetic results compared with traditional aortic valve surgery.

Several minimally invasive approaches have been developed for isolated aortic valve disease such as upper mini-sternotomy and anterior right mini-thoracotomy (ART). These approaches, when used in conjunction with a multidisciplinary team, provide improved outcomes compared to traditional full-sternotomy procedures and have reduced the need for cardiopulmonary bypass (CPB) [3, 4, 6, 7, 8].

Minimally invasive aortic heart surgery may be an excellent option for patients with severe aortic stenosis or mitral valve insufficiency. Your surgeon will assess your individual medical condition and chest anatomy to determine whether or not you are a candidate for MIAVR.

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