Minimally invasive surgery – which came to Cleveland Clinic in the mid-1990s – evolved to become the standard of care for isolated aortic and mitral valve disease. While minimally many heart centers around the country use invasive and robotic approaches for mitral valve surgery, aortic valve surgery can be more complex. The age of the patient, co-existing medical conditions and, often, the presence of vascular and/or aorta disease factor into the surgical approach.
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We tailor the specific incision to the patient based on the valve involved and the needs of the patient, according to Eric Roselli, MD, FACS, Director of the Aorta Center. Dr. Roselli and surgeon colleagues at the Cleveland Clinic were instrumental in developing several new minimally invasive surgery (MIS) approaches used to treat complex cardiovascular disease.
The standard approach for isolated valve operations at Cleveland Clinic is use of minimally invasive incisions. Newer treatments for aortic valve surgery through the MIS approach involve even smaller incisions between the ribs, alongside the breastbone. The result is a less invasive option that provides the benefits of the best valve technology and allows a faster recovery for the patient.
“Since we have so much experience with minimally invasive surgery, we even do complex operations through MIS approaches,” Dr. Roselli said, adding that MIS also is used with more complex double valve disease and in patients with aneurysm and valve problems. The goal is to provide patients with a safe and successful surgery with the smallest incision possible.
As changes in practice are adopted, it is important to look at the outcomes of the newer surgical approaches to determine safety and risk of complications. In general, the risks associated with cardiovascular surgery include death, stroke and other major complications.
Data published by the Cleveland Clinic compared outcomes for aortic valve surgery using MIS approaches vs. standard approaches. Over the 20 years of this study, operative mortality for isolated aortic valve surgery remained low and declined gradually to 0.5% in 2013 (remaining low in 2014).
Cleveland Clinic heart surgeons perform more than 1,700 aortic valve operations annually – with nearly one-third of those using minimally invasive techniques – and maintain mortality rates that are consistently below 1 percent. This is attributed to careful patient selection, appropriate use of preoperative imaging and selective conversion to open procedures when necessary.
“We found minimally invasive surgery is just as safe as full incisions with regard to death, stroke and heart attack, but it has the added benefits of fewer blood transfusions, shorter length of stay, earlier returns to work and less pain medication,” Dr. Roselli said, adding that MIS approaches also aid in recovery.
It is important to use preoperative testing and evaluation to plan the right procedure for each patient. In some cases, even when planning a minimally invasive approach, the surgeon may need to switch to an open procedure during the operation after visualizing the heart and blood vessels.
Surgeons at Cleveland Clinic work with a highly skilled multidisciplinary team to provide the highest level of care to patients.
“Our ability to rescue people when an adverse event happens is probably one of the most important factors that make us one of the best,” Dr. Roselli said. “We’re not only prepared as operators for when things happen differently than planned, but we have a whole multidisciplinary team that can coordinate a change in treatment in a moment’s notice.”