Keyhole Mitral Valve Repair - Avoid Rib Spreading and Use a Camera!

Wed 14 March 2018

Traditional mitral valve surgery is performed through a long cut in the middle of the breastbone. Although this is an effective technique, the incision takes 12 weeks to heal and can be associated with pain, bleeding and bone infection apart from being a rather unsightly scar. Keyhole mitral valve surgery is performed through a small cut between the ribs over the right side of the chest and has many attractions over the traditional approach: Less pain, less infection, less bleeding, and healing in days rather than weeks.

But even keyhole mitral valve surgery is performed in different ways and this can produce different results too:

Some surgeons use a rib retractor to spread the ribs apart in order to improve access to the heart. A more advance technique is to avoid rib spreading altogether and rely upon a special endoscopic camera to augment surgical vision in the belief that this non-rib spreading technique may produce less postoperative pain by avoiding ligament stretching or tension related rib fracture.

In a recent study (LINK HERE), 100 patients undergoing rib spreading keyhole mitral surgery and non-rib spreading keyhole mitral surgery were compared.  Postoperative pain rated on a pain-scale from 0 to 10 was significantly lower in the non-rib spreading group (mean difference of 1.8; P = 0.006). Significant differences were seen for operation times (39.0 min mean shorter operation time in the non-rib spreading group; P < 0.001), and length of stay on intensive care unit (1.0 day mean shorter stay in the non-rib spreading group; P = 0.002) and in the hospital (1.4 days mean shorter stay in the non-rib spreading group; P = 0.003). Mitral valve repair quality, heart function, perioperative morbidity and other heart related complications during follow-up showed no significant differences between both groups.

Non-rib spreading with endoscopic vision is our preferred technique at The Keyhole Heart Clinic. In men we perform a circumareolar incision around the right nipple for its superior cosmetic results, and in women we prefer a small cut under the right breast.

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