Specialist Procedures

Mr Paul Modi MD FRCS is a British, US and German-trained consultant cardiac surgeon with expertise in minimally invasive (keyhole) heart surgery.

Minimally Invasive Mitral Valve Repair

Mr Modi is one of only a handful of surgeons in the UK who regularly performs minimally invasive mitral valve surgery.

conventional-approach

The conventional way to approach the mitral valve is through a 12 inch incision on the front of the chest (median sternotomy, Figure 1).This gives very wide exposure for the surgeon but is very invasive for the patient and takes three months to recover from. Additionally, there are a number of important lifestyle limitations after this, which give time for the breast bone to heal back together:

  • No driving for six weeks
  • No lifting of anything heavier than a bag of sugar for six weeks
  • No pushing up from a bed or chair with your arms for six weeks

Figure 1. The conventional approach to the mitral valve (median sternotomy)

With the minimally invasive procedure, the surgeon uses a 2-3 inch incision on the right side of the chest and gently opens the space up between the ribs in order to see the heart. A high-definition video camera is then used to guide the procedure inside the heart. There are a number of benefits to this approach;

  • The recovery period is an average of about three weeks before the patient is back to normal activity although some recover faster than this and some recover slower
  • Less post-operative discomfort, particularly with the use of catheters that numb the pain nerves where the incision is placed
  • Superb cosmetic results, particularly in females where the scar is hidden under the right breast so ladies can wear a bikini at the beach and there would be no visible scarring. As one of my previous patients said to me, “Why would any woman want anything else?” (Figure 2)
  • Shorter hospital stay (about four days)
  • Lower chance of wound infection
  • The patient can drive again after two weeks
  • Restrictions and limitations on lifting and pushing up from a bed/chair do not apply

procedure

Figure 2. The cosmetic result of the minimally invasive procedure in men (A) and in women (B). In men a 2-3 inch scar is visible under the right nipple and in women there is virtually no visible scarring as the incision is hidden under the right breast allowing a bikini to be worn with no visible evidence the patient has had open heart surgery.

Am I eligible for the minimally invasive technique?

Most mitral and tricuspid valve repairs and replacements can be undertaken through this approach, although the most complex valves to repair are probably still best appraoached through a sternontomy (your surgeon will advise you on whether this is an option for you). Valve and ablation procedures (cryomaze) where an irregular heartbeat (atrial fibrillation) is corrected at the same time as the valve dysfunction are possible. Additionally, holes between the top two pumping chambers (atrial septal defects, ASD) and benign atrial tumours (myxomas) can be corrected / resected using this technique.

Who is not eligible?

  • Those who have had prior right lung surgery or radiotherapy to the right side of the chest
  • Those with peripheral arterial disease
  • Those who need concomitant bypass or aortic valve surgery

What are the risks?

The minimally invasive approach is just as safe as the conventional approach measured in terms of risk of dying and having a stroke. Valve repair rates are just as high with the minimally invasive approach. The evidence is consistent that these procedures take longer to perform, but despite this, patient recovery is much quicker.

In order to maintain safety there is always a 2% possibility of conversion to the conventional approach during the operation.

Minimally invasive surgery shortens the recovery time from heart surgery from approximately 3 months down to 3 weeks, although some recover faster than this and some recover slower. Prospective patients will find a wealth of information here to aid in their decision making when choosing their surgeon. Here are some examples and descriptions of Mr Modi’s areas of expertise in the field of minimally invasive cardiac surgery.

These demonstrate how he applies the latest pioneering techniques from the US and Europe to minimize the surgical access sites and thus achieve a more comfortable and rapid recovery for his patients. Please also have a look at the patients’ stories pages to read first-hand accounts of what it was like recovering from minimally invasive heart valve surgery.

Read “Heart Repair Made Simple” on The Guardian

Read “An alternative to open heart surgery” on The Telegraph