Since the 1990s, HealthLINK has been providing Yale-New Haven patients with informative and cutting-edge information as our experts comment on news ranging from teething to heart failure. HealthLINK: Cardiovascular considers issues from many heart-related disciplines that have bearing on the way all of us we eat, sleep, work and exercise.

March 2011

The benefits of minimally invasive valve surgery in older adults

A recent study conducted by Mount Sinai Medical Center in Miami Beach, FL, compared the outcomes of 203 patients age 75 and older who underwent heart valve replacement surgery. Of the 203 patients studied, 119 underwent minimally invasive surgery — which uses a smaller than normal incision — and 84 patients had the conventional surgery. The study, published in the January 2011 issue of the Annals of Thoracic Surgery, found that patients who had the less invasive surgery had significantly better outcomes that resulted in increased survival and reduced postoperative complications.

Arnar Geirsson, MD, is the director of minimally invasive cardiac surgery at YNHH and assistant professor of cardiothoracic surgery at Yale School of Medicine.

What the news means to you

Mount Sinai's study is the first published study that specifically compares the outcomes of minimally invasive heart valve surgery with conventional surgery in patients older than 75 years of age, which can be of significant importance in the health of the elderly population.

Minimally invasive heart surgery offers several advantages compared to open-chest procedures, including faster healing, less infection, reduced need for pain management, shorter hospital stays and faster return to normal activities.

Also called keyhole surgery, minimally invasive surgery is performed through small incisions, sometimes using specialized surgical instruments. The incision used for minimally invasive heart surgery is about 3 to 4 inches instead of the 6- to 8-inch incision required for traditional surgery. Minimally invasive surgery is more complex and demanding than the conventional open approach and requires the expertise of a qualified cardiothoracic surgeon. Though it has several advantages, not every patient is a candidate for this surgery.

At Yale-New Haven Hospital, our cardiac surgeons have expertise with the full range of minimally invasive surgery, including the right minithoracotomy — a keyhole incision made between the ribs that provides excellent cosmetic results — and the partial upper sternotomy — a 2- to 3-inch skin incision to the upper breastbone, which spares the collar bones and upper limbs. Operations that can be performed this way include valve surgery, beating heart coronary surgery and robotic assisted coronary bypass surgery, using the da Vinci Surgical System.

One out of every eight individuals over the age of 75 has moderate to severe valvular disease, and the number is expected to double by 2030, as our population ages. Many elderly patients, however, are denied intervention by surgical centers and excluded from studies due to old age.

This study positively confirms that minimally invasive valve surgery is feasible and should be considered for older patients who might otherwise not have access to valve surgery due to high risk. Elderly patients with heart disease, and their loved ones, need to know there are options for surgical intervention. Treatment decisions are based not on age alone but on a person's entire medical profile and mental outlook.

Learn more about Yale-New Haven Hospital's Heart and Vascular Services.

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