Keyhole Aortic Valve Replacement Surgery

Keyhole Aortic Valve Replacement at The Keyhole Heart Clinic

When you need an aortic valve replacement (AVR), traditional open-heart surgery has long been the standard approach. At the Keyhole Heart Clinic, we offer an alternative, minimally invasive procedure. Our keyhole heart valve surgery can help you heal faster without needing to break the breastbone. 

Top cardiac surgeon Mr Inderpaul Birdi has been performing aortic valve surgery and keyhole aortic valve replacement surgery for over two decades. This means that we are uniquely experienced in providing patients with an alternative procedure that has a faster recovery, less pain, and fewer complications in the long term.

Explore the details of our procedure for aortic valve replacement to support a faster, smoother return to your daily routine.

What Is the Aortic Valve & Why Does It Matter?

The aortic valve is the final point to allow blood flow from the heart into the aorta, sending oxygen-rich blood to the rest of the body. The pulmonary valve and the aortic valve are two of the main types of valves. They must open and close correctly to ensure proper one-way circulation.

Aortic valve problems occur when the valve opening becomes damaged, a condition known as aortic valve disease, which restricts or allows blood flow to leak backwards. This can impair heart function and lead to serious complications.

Types of Aortic Valve Disease

Aortic valve disease, a form of heart valve disease, includes:

1. Aortic Valve Stenosis

Aortic stenosis occurs when the valve leaflets become stiff or calcified. The now narrowed aortic valve has a tightened opening, restricting blood flow.

Symptoms may include:

• Breathlessness

• Chest pain

• Dizziness

• Fatigue

• Signs of heart failure

• High blood pressure

Without treatment, severe aortic stenosis can lead to heart failure or sudden cardiac death.

2. Aortic Valve Regurgitation

Aortic regurgitation occurs when the damaged aortic valve fails to close properly, allowing blood to leak backwards into the heart. The heart compensates by enlarging and pumping blood harder.

Common symptoms:

• Shortness of breath

• Fatigue

• Swollen ankles or feet

• Irregular heartbeat

3. Congenital Aortic Valve Defects

Most often, this involves a bicuspid aortic valve, which has two leaflets instead of the usual three. Though present from birth, symptoms may not appear until adulthood. This congenital abnormality increases the risk of early-onset valvular heart disease.

When Is Treatment Required?

As the damaged valves progress or symptoms worsen, treatment is often necessary. Interventions such as the replacement of the aortic valve or repair aim to improve blood flow from the coronary arteries and prevent further decline from heart valve disease.

Minimally Invasive Aortic Valve Replacement Surgery 

Aortic valve replacement operations can be performed through keyhole (minimally invasive) incisions that either divide only a tiny portion of the breastbone (Ministernotomy). In many cases, we can now avoid breast bone division altogether by making a small cut between the ribs on the right side of the chest (Anterior Right Thoracotomy or ART).

Below is a comparison of some of the main techniques and how they differ for the patient in terms of results:

Traditional (Invasive) Sternotomy

• Full Breastbone Division
• 12 weeks to heal
• Risk of bone infection
• Mild to moderate pain
• Cosmetically less appealing

Ministernotomy

• Less Pain / Bleeding
• Better Breathing
• Improved cosmetic appeal on sternotomy
• Quicker recovery than sternotomy

Anterior Thoracotomy

• No broken bone
• heals in 7 to 10 days
• Less Pain / Bleeding
• Better Breathing
• No bone infection
• Resume daily activities within days

With traditional methods being far more intrusive and longer to recover from, as well as being less cosmetically appealing, we generally prefer to offer suitable patients the minimally invasive aortic valve replacement operation. 

During your consultation, our medical experts, who have over 20 years of experience with keyhole aortic valve surgery, will be able to determine the most effective treatment.

Benefits of A Minimally Invasive Surgery for Aortic Valve Replacement  

Keyhole aortic valve surgery is a safe and effective procedure when performed in expert hands, which means that the speed of recovery takes days rather than months. 

The advantages of opting for a minimally invasive surgery to replace the aortic valve include:

• Quicker healing, better breathing, and swifter discharge from the hospital. 

• Our patients also love the improved cosmetic look of the incision. 

• The keyhole incisions have been shown to minimise the risk of infection and bleeding compared to the traditional full breastbone split.

• Compatible with the most advanced valve options available today

• Your surgeon can adjust the approach during surgery if needed

• Works even for patients who’ve had previous heart procedures

If you suffer from aortic valve stenosis or aortic regurgitation, minimally invasive aortic valve surgery could be the right approach for your long-term health.

Due to the unique surgical approach of this procedure, it often requires non-standard instruments and specialised techniques. The learning curve is steep, which is why choosing an experienced surgical team is essential to achieving the best outcomes.

General Complications & Risk Factors of Aortic Valve Replacement

Like any heart surgery, aortic valve replacement has certain risk factors and potential complications that you should be aware of.

Complications of AVR surgery can include:

• Bleeding, during or after surgery, due to human heart tissue being fragile

• Stroke or transient ischemic attack (TIA)

• Infection, including surgical site infection or endocarditis

• Heart block, sometimes requiring a permanent pacemaker

• Valve thrombosis (blood vessel clots), mainly with mechanical valves, which require lifelong blood thinners

• Valve degeneration, primarily with biological valves, which last around 10–15 years

• Mortality, though rare, is a risk, especially for high-risk patients

Risk factors influencing outcomes after AVR surgery include:

• Advanced age (especially over 80)

• Reduced left ventricular function,

• Chronic kidney disease, particularly elevated creatinine

• Lung conditions

• Previous stroke or TIA

• Urgent or emergency surgery

• Combined surgeries (CABG)

• Frailty or immunosuppression

• Multiple comorbidities

How The Aortic Valve Replacement Operation Helps Our Patients

Being able to offer a better alternative to traditional methods of heart surgery provides enhanced choice for patients with a recent diagnosis. Keyhole aortic valve surgery allows patients to live a better life for longer, without the need for intrusive methods. Receiving a diagnosis is difficult enough, but learning you’ll need to undergo a traditional sternotomy as well may leave you feeling even more anxious and concerned about the surgery.

We believe that the keyhole aortic valve surgery procedure is far more beneficial for patients, and having this option can help to alleviate the worries you may have about having a major operation. Knowing that you won’t need to undergo a break of your breastbone to access the heart, and instead, a smaller, much less intrusive surgical procedure is performed, will help reduce some of this worry.

Once the surgery is completed, you’ll also be able to return to your improved, everyday life quicker than through other procedures. With a greatly reduced recovery time, you will spend less time healing and more time enjoying the benefits that undergoing life-changing keyhole aortic valve surgery can bring.

Sutureless Aortic Valve Replacement Surgery

Sutureless replacement valves are essentially the same as traditional tissue valves, and the long-term durability of the prosthesis is excellent. The advantage of these valves lies in their ability to be deployed very swiftly. This makes them very suitable for patients who need a swift operation to reduce the risk of invasive surgery. They also facilitate minimally invasive AVR procedures because of their ease and speed of deployment.

FAQs on Aortic Valve Replacement Procedures

At The Keyhole Heart Clinic, we understand that heart surgery can feel overwhelming. Explore our answers to frequently asked questions about aortic valve replacement operations for your peace of mind.

What options are available for high-risk patients who can’t undergo heart surgery?

In high-risk patients who are not suitable for any heart surgery, an alternative treatment called Transcatheter Aortic Valve Replacement (TAVR or TAVI ) can be used as a way to offer patients some relief from their symptoms without the need for surgery.

The ongoing limitation of TAVR is the risk of leaks around the edge of the new valve, and the lack of long-term durability of TAVR valves, which makes them unsuitable for patients who need a good result beyond 3 to 5 years. Therefore, the best treatment for patients who are fit enough for heart surgery is still surgical replacement. 

What is the better option, transcatheter aortic valve replacement or aortic heart valve replacement surgery?

Choosing between keyhole aortic valve replacement and TAVR depends on several factors such as your age, overall health and the condition of your aortic valve.

Here’s a general guideline to help understand the options:

• Under 65: Surgical valve replacement is usually recommended, as it offers proven long-term durability.

• Over 80: TAVR is often preferred due to its lower risk and faster recovery in older patients.

• Aged 65–80: This is considered a “grey zone.” The best treatment option depends on a combination of medical, anatomical, and lifestyle factors, and should be decided in consultation with a specialist team.

While TAVR is less invasive and can be ideal for certain patients, one current concern is that long-term data on the durability of transcatheter aortic valve implantation are still limited. If you’re medically fit and anatomically suitable, surgery remains the most reliable option for lasting results.

Our team of cardiovascular medicine experts will help you decide which approach is best for you. 

How long does a replacement value last?

The lifespan of a replacement heart valve depends on the type of valve you receive, either a mechanical valve or a biological valve.

• A mechanical valve replacement is made from durable materials such as carbon and metal. These valves are designed to last a lifetime. However, they do require lifelong blood-thinning medication to prevent blood clots.

• A biological valve replacement is usually made from animal tissue, such as that of a pig or cow. A biological valve typically lasts between 10 and 15 years. This type is often recommended for older patients, as it avoids the need for long-term blood thinners.

Contact us to find out if keyhole aortic valve replacement procedure is right for your condition.

The Keyhole Heart Clinic: Expert Minimally Invasive Methods

The Keyhole Heart Clinic offers the kind of advanced treatment that was once out of reach, but is now available to you. Our clinic is led by Mr. Inderpaul Birdi, a Cardiothoracic Surgeon and Consultant with over twenty years of experience helping patients through complex heart procedures.

With qualifications including BMedSci (Hons) and BM BS FRCS (CTh), Mr. Birdi has dedicated his career to cardiology and developing minimally invasive methods that can lead to shorter recovery times and reduced discomfort for patients.

Enquire Today About Aortic Heart Valve Surgery 

We can help by arranging an appointment in our London heart clinic, or we can arrange for a remote consultation if this is more convenient for your circumstances. You’ll need to provide some short details, including your telephone and email address, and we will be able to get back to you quickly.

Want to learn more about The Keyhole Heart Clinic and our services and experience? We have further information in our conditions section as well as more details on our other services, including heart screening and our second opinion service. To hear from our expert medical team, including advice and insight, please see our helpful Videos section as well as read about what our patients have experienced in our Testimonials.

What We Offer

Mr Birdi specialises in keyhole cardiac procedures, such as:

• Keyhole mitral valve repair or replacement surgery

• Keyhole coronary bypass surgery (from single to quadruple bypass)

• Keyhole tricuspid valve replacement

• Keyhole atrial fibrillation ablation

• Keyhole atrial septal defect closure

• Heart screening

Mr Birdi is among a small group of cardiac surgeons worldwide who perform keyhole coronary bypass surgery and keyhole aortic valve repair. In 2022, he performed the UK’s first successful quadruple heart bypass using keyhole techniques—a milestone that reflects his commitment to advancing patient care.

Our Approach

We understand that receiving the news that you need to undergo heart surgery can leave you with many questions and concerns. Our main clinic is located in Harley Street, London. We also offer The Keyhole Essex Heart Clinic and The Keyhole Nottingham Clinic, where we have teams who can assist you with your diagnosis and treatment.

Book an appointment with our expert medical team today for a detailed consultation about aortic valve replacement surgery.