Minimally Invasive vs. Sternotomy: Which is Best for Heart Valve Patients?

Advancements in medical technology have expanded surgical techniques, giving heart valve surgeons and their patients more options than ever when planning an operation. A traditional sternotomy, where the breastbone is cut open, used to be the only way to access the heart. Now, minimally invasive techniques using 2 to 4 small incisions in the chest wall make it possible for patients to have a shorter hospital stay, less pain, and faster overall recovery. Given the two options, the easy choice for most patients would be a minimally invasive approach. However, there’s a lot more that goes into the decision for both patients and surgeons.

We recently received a patient question on this subject from Robert, who asked, “For my upcoming heart valve surgery, I’m evaluating different surgical approaches with different size incisions resulting from sternotomy or minimally invasive. I’m a bit lost. What do the experts think is the most important criterion for patients to consider for their surgery?” To answer Robert’s question, Adam Pick, founder of HeartValveSurgery.com, spoke with Dr. Juan Pablo Umana while they were attending the American Association for Thoracic Surgery meeting in Chicago, Illinois. Dr. Umana is the Chief of Cardiac Surgery at the University of Miami Health System in Miami, Florida, where he specializes in minimally invasive heart surgery.

Video available online at:

https://www.youtube.com/watch?v=TfAt-Wz_cPw

Facts About Sternotomy vs. Minimally Invasive

Here are the key insights shared by Dr. Umana:

• The type of incision is dependent on the operation. Dr. Umana said, “The important thing is what is done inside. How we get there and what access we use should be totally secondary. Depending on the operation you need, whether it’s a valve sparing root replacement, a Ross procedure, or an aortic valve replacement versus an aortic valve repair, we can start tailoring the type of incision needed to perform the operation.” Dr. Umana explained that a minimally invasive approach is ideal for a standard aortic valve replacement. “It’s better cosmetically and probably has a faster recovery.” However, Dr. Umana said that the size of the incision becomes secondary in procedures such as an aortic valve repair, re-implantation, root remodeling, or a Ross procedure.

• A surgeon decides on incision type to achieve better overall goals. “I think the main message is that we do the right operation for the right patient, and the incision must be tailored according to what operation is going to best suit the patient. We look at what will make a patient’s life better, increase life expectancy and quality of life while also recovering heart function.”

Thanks Dr. Umana and the University of Miami Health System!

On behalf of all the patients in our community, thank you, Dr. Juan Pablo Umana, for everything you and your team are doing at the University of Miami Health System in Miami, Florida!

Related links:

• See Dr. Juan Pablo Umana's Interactive Surgeon Profile

• Ask Dr. Juan Pablo Umana: Am I Too Old To Get A Ross Procedure?

• Explore the University of Miami Cardiac & Vascular Center Heart Valve Microsite

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Umana below.