Heart valve repair and replacement surgery has conventionally been done by dividing the entire breastbone, as part of a procedure known as a sternotomy, to gain access to the heart. This, by the very nature of the surgery, is an extensive procedure with a recovery time of between six and eight weeks, and even longer in some more complex cases.
A reduction in the hospital stay and recovery time are some of the reasons why cardiothoracic surgeons around the world are increasingly looking to minimise the size of surgical incisions they use, including when performing heart valve repair and replacement operations.
“With minimally invasive surgery, there also tends to be less bleeding during surgery, reduced post-operative pain, wound complications are less likely, and the cosmetic results are better than with a sternotomy, all of these factors being of significant benefit to the patient,” says cardiothoracic surgeon Dr Kaveer Sohan, who practises at Netcare Union Hospital in Alberton, Johannesburg.
Managing director of the Netcare hospital division, Jacques du Plessis, says that Dr Sohan and his team at the hospital have successfully performed a series of minimally invasive mitral valve repair surgeries via much smaller incisions than traditional open surgery.
The procedure, which is only offered at only a few hospitals in South Africa, involves undertaking the surgery through an incision of between 4cm to 6cm to the right of the sternum, which is known as a ‘right mini-thoracotomy’.
Dr Sohan, who has been assisted by fellow cardiothoracic surgeon, Dr Jaco Botha, says that as a result of the advantages this technique, it is now being offered as a standard option at Netcare Union Hospital in patients for whom it is established to be the most appropriate approach.
“While the minimally invasive mitral valve repair surgery maintains the efficacy and safety of a conventional approach, it has been shown to be less invasive, enabling patients to recover faster with shorter hospital stays,” adds Dr Sohan, who underwent training in the procedure in France last year.
“It is for these reasons that this approach to heart valve repair is becoming an increasingly popular alternative to traditional open cardiothoracic surgery around the world. The procedure does take longer to perform and is not appropriate in all cases, but patients and funders do appreciate the shorter recovery periods,” notes Dr Sohan.
The heart valve repair and replacement procedures undertaken via smaller incisions tend to reduce hospital stays and recovery times compared with the traditionally used approach of dividing the entire breastbone. Shown here are mini-sternotomy (picture 1), mini-thoracotomy (picture 2) and full sternotomy (picture 3) incisions post-surgery.
One of the patients who recently had a diseased mitral heart valve repaired by means of the right mini-thoracotomy was Eddie Hammond of Johannesburg. After a thorough assessment of his condition at the hospital’s heart centre, it was recommended that the newly introduced approach be used in his case.
“Mr Hammond recovered quickly after the procedure, and was in good spirits and mobile the following day. He was discharged from hospital after five days and reports being pleased with the outcome of the operation. He also said that he was most grateful that this option was available to him.”
Mr Rui Couto, an executive from Johannesburg who underwent the first mini mitral heart valve repair procedure to be completed at Netcare Union Hospital recently, is also grateful to have been treated by means of this procedure rather than have a full sternotomy.
“Late last year, I was having problems with my energy and had a constant phlegm build-up in my chest,” relates Mr Couto. “I was referred to cardiologist, Dr Jean-Paul Theron, at the hospital who investigated and to my alarm found I had snapped a mitral valve tendon that was causing it to malfunction.”
“I am pleased to say that the mini-thoracotomy undertaken by Dr Sohan and his team went well. I was back at work and in the gym doing light cardio workouts within six weeks. The incision is hardly visible now and I am also pleased with the result from a cosmetic perspective. The surgical team were outstanding, and I am most thankful to them,” he adds.
Dr Sohan and his team have collaborated with Dr Jacques Scherman, a cardiothoracic surgeon who practises at UCT Private Academic Hospital and Groote Schuur Hospital in Cape Town. Dr Sohan said he is grateful that Dr Scherman, who has established a minimally invasive heart valve repair centre in Cape Town, was able to share his considerable expertise with the Netcare Union Hospital team.
According to Du Plessis, this new approach to heart valve repair has formed part of an initiative to develop a minimally invasive heart surgery centre at Netcare Union Hospital. Dr Sohan and his team are also undertaking minimally invasive aortic heart valve replacement procedures, a number of which have been successfully completed at the hospital so far.
“We are most gratified that Dr Sohan and his team have developed this surgery centre at the hospital, which will be of great benefit to our patients in the region who qualify for these new approaches to heart surgery,” adds Du Plessis.
Dr Sohan explains that the potentially life-saving minimally invasive aortic heart valve replacement procedure, in which diseased heart valves are replaced with artificial valves, are also undertaken through smaller incisions and share the same advantages as the minimally invasive heart valve repair procedures. They are undertaken using a mini-sternotomy through an incision of between 5cm to 7cm.
Dr Sohan says that the predictors of successful valve repair or replacement are largely assessed using 3D transoesophageal imaging techniques which are performed at the Structural Heart Disease Centre at Netcare Union Hospital with the multidisciplinary ‘Heart Team’ approach.
“The multidisciplinary cardiac team at Netcare Union Hospital brings a high level of expertise and dedication to the profession, and the latest surgical techniques to our patients with diseased heart valves who require heart valve repair or replacement procedures,” commented Esme Abrahams, Netcare Union Hospital general manager.
Issued by: Martina Nicholson Associates (MNA) on behalf of Netcare Union Hospital
Contact: Martina Nicholson, Graeme Swinney, and Meggan Saville
Telephone: (011) 469 3016
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