Valve Surgery – Incision Options (Dr. Eric Roselli)

Minimally invasive heart surgery (also called keyhole surgery) is when a conventional operation is performed on or inside the heart using small incisions. The surgeon also sometimes uses specialized instruments.

Who Is a Candidate for Minimally Invasive or Robotic Surgery?

There are many ways to reach the heart for surgery. Surgeons at Cleveland Clinic always try to use the smallest incision to provide the safest and most successful surgery. Your surgical team will carefully compare the advantages and disadvantages of minimally invasive techniques with those of traditional surgery techniques. Your surgeon will decide the best approach for you based on several factors, including the type or heart disease you have and how severe it is; your age, medical history and lifestyle; and results of tests done before surgery.

Traditional Heart Surgery

traditional heart surgery

Traditional heart surgery uses an incision through the middle of your chest, through the breast bone. The incision is about 6 to 8 inches long.

This is the safest and most commonly used incision for patients who need complicated heart surgeries, reoperations, multiple coronary artery bypass procedures or complex aorta procedures.

Types of Minimally Invasive Heart Surgeries

Cleveland Clinic surgeons have performed minimally invasive heart surgery since the mid 1990s. The first surgeries of this type were mitral and aortic valve surgeries. Now, a wide range of procedures can be done using minimally invasive techniques to help make recovery faster and more comfortable.

Sometimes, minimally invasive surgery includes a partial sternotomy. This involves cutting through part of the breast bone. When possible, the surgeon can avoid cutting the breast bone and, instead, make one or more small incisions through the muscles between the ribs. This technique is called a mini-thoracotomy.

Robotically assisted heart surgery

Most types of robotically assisted heart surgery are used to treat patients with mitral regurgitation (leaky mitral valve). Robotically assisted heart surgery can be used for:

Last reviewed by a Cleveland Clinic medical professional on 07/22/2019.

References

  • Gillinov M, Mihaljevic T. The Future of Mitral Valve Surgery. Tex Heart Inst J. 2012; 39(6):840–841. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528247/
  • Iribarne A, Easterwood R, Chan EYH, Yang J, Soni L, Russo MJ, Smith CR, Argenziano M. The golden age of minimally invasive cardiothoracic surgery: current and future perspectives. Future Cardiol. 2011 May; 7(3):333–346.
  • Johnston DR, Roselli EE. Minimally invasive aortic valve surgery: Cleveland Clinic experience. Ann Cardiothorac Surg 2015;4(2):140-147 :
  • Malaisrie SC, Barnhart GR, Farivar RS, Mehall J, Hummel B, Rodriguez E, Anderson M, Lewis C, Hargrove C, Ailawadi G, Goldman S, Khan J, Moront M, Grossi E, Roselli EE, Agnihotri A, Mack MJ, Smith JM, Thourani VH, Duhay FG, Kocis MT, Ryan WH. Current era minimally invasive aortic valve replacement: techniques and practice. J Thorac Cardiovasc Surg. 2014 Jan;147(1):6-14. Epub 2013 Nov 1.
  • Mihaljevic T, Koprivanac M, Kelava M, Avi Goodman A, Jarrett C, Williams SJ, Gillinov AM, Bajwa G, Bonatti J, Blackstone EH. Value of robotically assisted surgery for mitral valve disease. JAMA Surg. 2014 July; 149(7): 679-686.
  • Secchin Canale L, Mihaljevic T, Nair R, Bonatti J. Robotically assisted totally endoscopic coronary artery bypass surgery. J Thorac Dis. 2013 November; 5(Suppl 6): S641–S649.
  • Society of Thoracic Surgeons

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