Minimally Invasive Aortic Valve Replacement

Minimally invasive Aortic Valve Replacement or MICS AVR often referred to as mini AVR or key hole aortic valve replacement is the technique of aortic valve replacement through a small non bone cutting incision from the right side of the chest. It was first performed in 1996. The first few MICS aortic valve replacements were performed by groups at the Harvard Medical School’s teaching Hospital, Brigham and Women’s Hospital in Boston and the Cleveland Clinic. MICS AVR has been performed for close to two decades and has an excellent track record of safety. When performed by trained surgeons who regularly perform minimally invasive procedures the outcome is definitely superior to the conventional technique.

There are two techniques by which MICS Aortic Valve Replacement can be performed. The Right anterior thoracotomy approach (RAT) does not require any bone to be cut. The Upper hemisternotomy technique requires the upper part of the sternum or breastbone to be cut.

Right Anterior Thoracotomy (RAT) Approach

In this superior technique of minimal invasive aortic valve replacement the aortic valve is approached between the ribs on the right side. No bones are cut. Exposure is excellent and the technique of replacement is similar to the open operation. The advantages of this approach are

• No bones are cut.
• Significant reduction in pain.
• It allows for much faster healing. The cut is a mere 4cms.
• Skin infection is near zero and as no bone is cut the dreaded bone infection (Osteomyelitis) is eliminated.
• Not cutting the bone also decreases blood loss during the operation and this in turn translates into significantly reduced need for blood transfusion and the related complications of kidney failure and lung injury.

The Upper Hemisternotomy Approach

In general, recovery after a heart operation is influenced by the patients health prior to surgery. In those who have been active prior to their heart operation discharge from the hospital could be as early as 48 hours. When a parasternal approach has been used for valve replacement most patients can resume all normal activity within a week after discharge from hospital. Below are answers to a list of questions that patients frequently ask following their heart surgery. Please note that this is only a general guide and any special instructions given to you in particular, at the time of discharge, must be followed.