Minimally Invasive Heart Surgery: A New Era in Valve Disease Treatment Offering Reduced Burden, Faster Recovery, and Enhanced Quality of Life

Among these, ‘heart valve disease,’ particularly Mitral Valve Disease and Aortic Valve Disease, are common conditions primarily driven by age-related degeneration, rheumatic fever, genetics, infections, and other chronic illnesses.

Assistant Professor Dr. Siam Khajarern, a Cardiothoracic Surgeon at Ramathibodi Hospital, explains that heart valve disease manifests in two main forms: ‘stenosis’ (narrowing) and ‘regurgitation’ (leaking). Stenosis occurs when the valve thickens or calcifies, obstructing blood flow, while regurgitation results from valve deterioration or tears, causing backward blood flow. Both conditions strain the heart and predominantly affect individuals aged 40 and above due to prolonged cardiac workload and associated risk factors such as hypertension and hyperlipidemia. Patients often experience increased fatigue, chest tightness, arrhythmia, palpitations, fainting, leg swelling, or orthopnea. Prompt medical attention is crucial for diagnosis and appropriate treatment to prevent heart failure, a potentially life-threatening complication.

Diagnosis of heart valve disease involves a comprehensive approach, including medical history review, physical examination, chest X-ray, and echocardiogram (Echo) to assess the severity, categorized as mild, moderate, or severe. Mild cases are typically managed with medication and lifestyle modifications to alleviate symptoms and slow valve deterioration. However, more severe cases may necessitate valve repair or replacement with a prosthetic valve to restore efficient cardiac function.

Treatment options for heart valve disease include two primary methods:

1. Standard Open-Heart Surgery (Conventional Heart Surgery): This globally recognized and highly safe procedure with well-established long-term success involves a 15-20 cm incision in the middle of the chest and cutting the breastbone to access and repair or replace the affected valve. The recovery period is typically around three months before full physical activity and normal life can be resumed.

2. Minimally Invasive Cardiac Surgery (MIS): This advanced technique minimizes surgical incision size and reduces disruption to the body’s structures. Various approaches exist, including partial sternotomy, anterior thoracotomy through the right chest, or sub mammary incision on the right side, depending on the valve being addressed. The benefits include smaller incisions (approximately 4-5 cm) and the use of specialized instruments and cameras for precise surgical intervention. This method avoids cutting the breastbone or fracturing ribs.

Currently, minimally invasive heart surgery is not limited to Mitral and Aortic Valve Disease but extends to treating a range of other cardiac conditions, including coronary artery disease, cardiac arrhythmias, and heart tumors.

Key advantages of this technique include significantly smaller incisions compared to traditional surgery, leading to less tissue and organ trauma, avoidance of bone fractures or cutting, reduced risk of infection, less blood loss, faster patient recovery, shorter hospital stays, and a quicker return to daily activities.

Assistant Professor Dr. Siam Khajarern emphasizes, “While minimally invasive heart surgery is gaining popularity due to its reduced invasiveness, faster recovery, and quicker return to daily life, it may not be suitable for all patients, especially those with complex comorbidities or emergency conditions such as severe coronary artery disease or multi-valve damage. The attending physician will conduct a thorough evaluation. Furthermore, this technique requires a highly skilled surgical team with extensive training and experience in minimally invasive heart surgery (at least 50-120 cases), working collaboratively with a specialized multidisciplinary team to ensure treatment efficacy and safety comparable to traditional surgery, with patient safety as the top priority.”