Modern heart surgery
Prof. Dr. Jürg Grünenfelder is a specialist in cardiothoracic vascular surgery at Heart Clinic Hirslanden. His particular area of expertise is minimally invasive mitral valve reconstructions. This low-impact operating technique offers patients the best possible results and helps them get back on their feet faster.
Prof. Dr. Grünenfelder, what is a mitral valve reconstruction?
Prof. Dr. Jürg Grünenfelder: The mitral valve is one of the heart’s four valves and it is located between the left atrium and the left ventricle. Every time the heart contracts, it prevents the blood from flowing back into the atrium. The valve leaflets are directly connected to the heart muscle by tendinous chords, so that they are tightly sealed with each contraction. If those chords are faulty or the leaflets are perforated or overstretched, then the valve can no longer seal completely. During the mitral valve reconstruction, those faults are rectified so that the heart can once again operate at full capacity.
How do those defects occur?
Prof. Dr. Jürg Grünenfelder: Some people are born with valve defects, others develop them later in life due to a genetic predisposition or weakness of the connective tissue. Unfortunately there are no preventative measures available, because there are no known risk factors. Mitral valve defects are not rare, in fact they are one of the most common valve disorders.
How is the disorder identified?
Prof. Dr. Jürg Grünenfelder: Mitral valve disorders often remain hidden. Diagnoses are usually made when patients visit their family doctor for a check-up and an unusual heart murmur is detected. If the disorder goes untreated over a longer period of time, it can lead to reduced cardiac performance, limited heart functioning, atrial fibrillation or an enlarged heart. It usually affects people from the age of 60 and over.
Which patients are advised to have surgery?
Prof. Dr. Jürg Grünenfelder: Heart operations always entail a certain degree of risk. That is why you should always weigh up whether surgery is really necessary. Mild or moderate cases are usually left untreated, because an operation would only achieve a comparatively small improvement to the person’s quality of life. Operations are only recommended for serious cases.
However, it has also been shown that early treatment is worthwhile, particularly in relation to the mitral valve. If the patient has already developed those serious symptoms I mentioned, then an operation will have less satisfactory results than if they had immediately undergone surgery. Essentially surgery is advisable for every patient suffering from a mitral valve defect. But generally speaking, you could say that it is our younger, fitter patients who are around 50 to 70 years old that will particularly benefit from an operation – they can expect a significant increase in their quality of life and life expectancy.
Can you describe the operation in greater detail?
Prof. Dr. Jürg Grünenfelder: A mitral valve operation usually involves what is known as a sternotomy. That means the breastbone is opened to expose the heart. This procedure requires a relatively large incision that’s around 15 to 20 centimetres long. The minimally invasive operation is carried out through a much smaller incision on the patient’s side, about five to six centimetres above the ribs, which are spread apart so that the instruments can access the heart. A heart-lung machine is used in both instances – with the open technique it is directly attached through the opening in the breast bone, whereas with the minimally invasive procedure it is inserted via the groin vessels. The length of each operation is also very similar.
What are the advantages of a minimally invasive mitral valve operation?
Prof. Dr. Jürg Grünenfelder: There are several: the smaller opening makes the operation much less burdensome. There is also less blood loss and a reduced risk of subsequent infection and kidney failure, so on average the patient can leave the hospital sooner. Accessing the heart from the side, gives the surgeon a better direct view of the mitral valve, which makes this complex operation somewhat easier. In most cases the valve can be reconstructed and does not need to be replaced with a prosthesis. A prosthesis constitutes a foreign body and may stop working properly after a certain amount of time.
What is the recovery period like?
Prof. Dr. Jürg Grünenfelder: Our patients usually recover very quickly from this modern, minimally invasive surgery. Most are able to leave the hospital and go home after five or six days. Nevertheless, they still need to take it easy after that, or they might be sent to do some rehabilitation. In most cases however, the rehab is significantly shorter than it is for patients who had open heart surgery.
Is the minimally invasive version of this surgery well established?
Prof. Dr. Jürg Grünenfelder: Heart Clinic Hirslanden is one of only a few hospitals in Switzerland where minimally invasive mitral valve surgery is routinely performed. Internationally this method is already replacing the open heart version and becoming the standard procedure, not least because of the many advantages for the patient that I mentioned earlier. It achieves the same result, but with a smaller wound.