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Minimally invasive heart surgery is when a conventional operation is performed on or
inside the heart using small incisions. The surgeon also sometimes uses specialized
instruments.

Who Is a Candidate for Minimally Invasive Surgery?

There are many ways to reach the heart for surgery. Surgeons at our clinic always try
to use the smallest incision to provide the safest and most successful surgery. Your
surgical team will carefully compare the advantages and disadvantages of minimally
invasive techniques with those of traditional surgery techniques. Your surgeon will
decide the best approach for you based on several factors, including the type or
heart disease you have and how severe it is; your age, medical history and lifestyle;
and results of tests done before surgery.
The benefits of minimally invasive surgery include:
    • Small incisions
    • Small scars
Most patients also have
    • Less pain
    • Shorter hospital stay after surgery
    • Lower risk of infection
    • Lower risk of bleeding and blood transfusion
    • Shorter recovery time and faster return to normal activities/work

Mitral Valve Repair

Why Repair Is Better Than Replacement

Mitral valve repair is the best option for nearly all patients with a leaking (regurgitant)
mitral valve and for many with a narrowed (stenotic) mitral valve.
Compared to valve replacement, mitral valve repair provides better long-term
survival, better preservation of heart function, lower risk of complications, and usually
eliminates the need for long-term use of blood thinners (anticoagulants). For these
reasons, we are committed to mitral valve repair, when possible.

Advantages of Mitral Valve Repair:

    • Better early and late survival (Longer life!)
    • Improved lifestyle
    • Better preservation of heart function
    • Lower risk of stroke and infection (endocarditis)
    • No need for blood thinners (anticoagulation)

Heart valve disease occurs when your heart's valves do not work correctly. Common
causes of valve disease include rheumatic fever, birth defects, degeneration over
time and infection. This can be caused by valvular stenosis or valvular insufficiency.

Can heart valve disease be treated?
Heart valve disease can be treated by:
    1. Protecting your valve from further damage
    2. Taking medications
    3. Having surgery or invasive procedures if necessary
    4. Seeing your heart doctor for regular visits

Protecting your valve from further damage

All patients with heart valve disease should talk to their doctor about the increased
risk of getting infective endocarditis. This infection can greatly damage or destroy the
heart valves, and can be fatal. You are at risk even if your valve has been repaired or
replaced during surgery. To prevent infective endocarditis:
    • Tell your doctors and dentist that you have valve disease.
    • Call your doctor if you have symptoms of an infection.
    • Take good care of your teeth and gums.
    • Take antibiotics before any dental procedures, major or minor surgeries, or invasive tests.

The decision to prescribe medical treatment, surgical repair or surgical replacement
depends on several factors, including the type of valve disease, the severity of the
damage, your age and your medical history. Often, the surgeon and cardiologist will
know which treatment will be best before surgery is performed. Other times, the
decision is best made by the surgeon during surgery, when the valve can be seen.
Often times, valve surgery may be combined with other procedures (such as more
than one valve procedure, bypass surgery or surgery to treat atrial fibrillation) to fully
treat the patient’s heart disease.

We evaluate each patient with a special care for minimally invasive surgery then we
make a joint decision with the patient to choose the best and safest approach.

Especially, with the infra-axillary incision and with endoscopic surgical techniques
with minimally invasive approaches, not opening the chest bone longitudinally all the
way or not cuting the chest bones in anyway provides a great convenience for
patient. Since the incision is small in this surgery, there will be less bleeding,
decreasing the need for blood transfusion. In addition, the post-op pain is reduced.
Patients can especially get out of bed in early stages, can sleep in any position after
the surgery without the need to lie down on their back, can turn their left or right
freely. After the surgery, patients can get out of bed or lay down on their own with
being able to use their arms, and they can easily meet their daily needs.

This surgery is a great comfort for obese patients or patients with sleep apnea
considering the fact that there’ll be no need for laying on back for long periods of
time. Avoiding the risk of opening of the sternum is especially important for obese
patients, old patients or patients with osteoporosis.
Patients can get back to their daily lives easier and faster. They can also air-travel.
Patients can drive shortly after the surgery and they can wear seatbelts without the
fear of getting any impact on their chests.

In these surgeries that performed under the armpit, even patients may not see the
post-op scar. The scar becomes obsolete in a month period. Especially young people
and women choose to have this surgery because of this reason. After the operations
with midsternotomi that partedchest bone all along, sexual intercourse is prohibited
until patient’s chest bone is rejoin. Patient have to protect their chest from getting any
impact on their chests. They can’t use their arms freely. Short after the operations
with infra-axillary incision, patients can return to their normal performance. They don’t
have to hide their chest, they can swim in a pool or in the sea, and other people won’t
be able to understand that the patient had a heart surgery.

Since the incision is little and there is no bone cut, infection risks are reduced.
There is no risk of the sternum healing in a wrong shape (risk of sternal dehiscence
after the operation) which happens especially in obese patients or old patients.

The risk of the need of reoperation is reduced.

No longer should people be afraid of heart surgery, but they should be afraid to be
late to have the surgery. It shouldn’t be forgotten that every day passing without
having surgery may lead to heart failure. Having check-up and examination intime,
having surgery when suggested, being able to decide to have the surgery is essential
and can save your heart. These surgeries should be performed by surgeons who are
experienced, and who have studied minimally invasive approach, who are open to
new methods, innovative and have successful results from these operations.

Infra- axillary cardiac valve operations:

This recent cardiac surgery method is applied with a small right infra-axillary incision
(approximately 5-6 cm wide), thus giving the cardiac surgery the possibility to be carried out
with an intercostal approach, avoiding any incisions to the muscles, ribs or the sternum.

– Mitral Valve Repair and Replacement
– Aortic Valve Replacement
– Tricuspid Valve Repair and Replacement
– Double Valve Replacement, mitral valve surgery and concomitantly aortic valve and/or tricuspid valve surgery
– Mitral valve surgery and concomitantly RF ablation for atrial fibrilation
– Cardiac valve surgery and concomitantly isolated right coronary artery bypass operations
– ASD and/or VSD (Atrial and/or Ventricular Septal Defect) Repair
– Removal of Intracardiac Tumors

Which patients can be applied this technique?

This Infra- Axillary Incision technique can be applied for young or old; obese or thin; male
or female, all patients with single or multiple heart valve disease or patients requiring cardiac
septal defect repair, removal of intracardiac tumors or cardiac valve surgery concomitantly
RF ablation for atrial fibrilation.

How is Cardiac Surgery with Infra-Axillary Incision performed?

An incision (approximately 6-8 cm) starting from the right armpit, going parallel to the breast
line is made to create access to the heart valve between the ribs. In most cases, by using tools
and endoscopic imaging techniques, the incision can be reduced in size and the surgery
becomes easier, more comfortable and safer for the patient with the help of video assisted
endoscopic surgery techniques.

What are the advantages of Cardiac Surgery with Infra-Axillary Incision
by using endoscopic surgical techniques?

– Patient recovers faster after the surgery,
– Post-operative recovery time in the ICU and in the hospital shortens,
– Need for blood transfusion reduces,
– Post-operative pain reduces,
– Patient can sleep in any position after this surgery. No need to lie down on back for long periods of time like in patients had undergone open-heart surgery with sternotomy
– This surgery is a great comfort for obese patients or patients with sleep apnea considering there’s no need for laying down on back for long time.
– After the surgery, patients can get out of bed on their own, and can cough without the risk of opening of the sternum like open-heart surgery patients.
– Avoiding the risk of opening of the sternum is especially important for obese patients, old patients or patients with osteoporosis.
– Post-operative wound heals quicker.
– Hypertrophic scarring (keloid) which is more likely to occur in surgeries with sternal incisions, is almost none with this surgery technique.
– Low risk of infection since the opening of the sternum is avoided.
– Patients gets discharged earlier.
– Patients can get back to their daily lives easier and faster.
– Patients can drive shortly after the surgery Patients can also air-travel.
– Patients can wear seatbelts without the fear of getting any impact on their chests.
– Patients can use their arms freely, can lift weight and can swim.
– Since the incision is made on the armpit, it’s less likely to be seen ensuring better cosmetic results.
– Because of this technique has a high aesthetic level, it is preferable, especially among young people and women.