What Is The Difference Between Ministernotomy And Minithoracotomy Aortic Valve Replacement?

Aortic Regurgitation

One of the commonest questions we are asked by patients in clinic is “what is the difference between a keyhole ministernotomy aortic valve procedure and a keyhole minithoracotomy aortic valve procedure?”

Well, before we explain these two procedures, let us go one step back and talk about the traditional way that we operate on the aorta or the aortic valve. The usual way to do that is through what’s called a median sternotomy which involves full division of the breast bone. We divide the breast bone using a controlled saw, and we can do pretty much anything to the heart through that approach. We can certainly replace or repair the aortic valve. Now, the problem with the median sternotomy is that it is a big cut which takes 12 weeks to heal. This is undoubtedly a significantly protracted period of time when you have to avoid and strains that could create breastbone movement as this will prevent proper bone healing .

Ministernotomy Aortic Valve Surgery

Fortunately, some surgeons are able to perform aortic valve surgery through what’s called a ministernotomy. This is a way to do the surgery without breaking the whole breast bone, but just breaking the upper third of the breast bone. What this allows the surgeon to do is leave most of your breast bone intact. This reduces the risk of infection, the risk of bleeding, and certainly it hurts a lot less. Patients can breathe a lot easier after a ministernotomy. Now, the problem with a ministernotomy is that it still takes 12 weeks to heal.

Minithoracotomy Aortic Valve Surgery

This is why Inder Birdi and the team at At The Keyhole Heart Clinic prefer to perform aortic valve replacement and repair surgery through a mini thoracotomy, a little cut between the ribs on the right hand side. Now the big difference between the minithoracotomy and the ministernotomy is that with the minithoracotomy, there is no broken bone. This means that the wound or the incision can heal in seven or eight days. This approach is very attractive in terms of getting patients back to all the activities they like to do so much quicker.


In order to assess you for minithoracotomy aortic valve replacement, the surgeon will check your echocardiogram to make sure that the diagnosis of aortic valve disease is correct. We will do an angiogram, if you’ve not already had one done to make sure your heart arteries are healthy. Finally we would perform a CT scan of the aorta to assess the suitability for us to place micro pipes in the groin. This allows the surgeon to do the minithoracotomy aortic valve replacement without spreading the ribs or cutting any bones. This is really why this incision is so attractive because it then allows us to reduce your pain significantly, reduce the risk of infection and bleeding significantly. Also, the rate of wound healing is a matter of days rather than weeks.

If you want to learn more about ministernotomy aortic valve replacement, and minithoracotomy aortic valve replacement, you can listen to Mr Birdi in this video below.

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