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British Heart Foundation
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Minimally invasive mitral valve surgery

Hi, I’m new here and wondered if anyone has undergone keyhole surgery as opposed to open heart surgery with the NHS?

I have been referred for surgery and am trying to find out if there is a choice for patients or if this is reserved for people not fit enough for conventional surgery?

Any info on this would be much appreciated 😊

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Hi and welcome to the forum! They do minimally invasive surgery on the NHS. However, it depends on what the surgery is for. Only certain arteries can be bypassed or valves treated this way. When I was having my bypass a lady of about 80 seemed to be recovering very fast and it turned out she had a minimally invasive valve repair. If you post more details someone may be able to comment more accurately on your case.

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Hi MichaelJH and thanks for your reply. I hope you are doing well after your surgery.

I have mitral valve prolapse/regurgitation and my recent TOE showed it to be moderate/severe so borderline for surgery. It has been moderate for many years but as I am now getting symptoms of breathlessness etc, the cardiologist felt it is now time to look at having surgery. I will be having an angiogram soon so will know if my arteries are ok. Fingers crossed that it could just be a repair to the valve and then suitable for mini surgery if I was able to get this through the NHS. The only thing I have heard is that this is sometimes available for older, more frail patients unable to have open heart surgery.

Thanks in advance for any info on this!

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Both mitral valve replacement can be done by minimally invasive techniques. Much depends on the angiogram results. Mine showed the LAD was 85% blocked and three others over 70%. Added to this there was a high degree of calcification meaning stenting was not an option. If you issues are limited to the mitral valve you may need referral to another hospital as not all surgeons are familiar with minimally invasive valve surgery. Good luck with your angiogram and subsequent discussions with your cardiologist.

Please note I am not medically qualified but a physicist who works in the medical sector.

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Thank you so much for this info on the arteries. I had a previous angiogram around 3yrs ago which showed only mild narrowing in the front artery, so provided my statin/aspirin/diet has helped and this has not deteriorated further, I am hoping things haven't changed!

I think it important to get another Cardiology appointment before I see a surgeon, as I would like to pursue the mini-mitral surgery (to an appropriate hospital) if at all possible.

You have been very helpful and it was reassuring to know about the 80yr old progressing well after her surgery!

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Good luck. I was in your shoes last month and just had my repair. I was lucky but trying to find out about this brain fog. I got the surgery from the side of the ribs as I felt the traditional would take too much out of me. I am hoping to get back to starting a heart health program physio this week. In America we don’t have some of the home care help you have.

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Hi, I’ve read the recovery time for minimally invasive is quicker than OHS. Weeks rather than months, however everyone is different depending on age/lifestyle etc. I’m sure you’ll soon start to feel fitter but will be gradual. I’m still ‘waiting’ to unable to pass on post surgery experience. There is a group on FB called Mitral Valve Repair Patients Group which would be worth joining as lots of advice following surgery. A lot of fellow Americans on this site who have also had mini-mitral surgery.

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Hi Sims, I have had the minimal invasive surgery here in Australia, but it is still in the trial stages. You could check if there are any trials in your region, I know there are currently 50 on the Twelve/Medtronic trial. It is still only available to pretty sick people who the option of bypass is not viable and there are a lot of other prerequisites. I don't know your major hospitals over there, but you could do a bit of ringing around and you might find one that is conducting the trials. The Mitral Valve is much more intricate than the other valves, and this is just a new procedure. I had mine done 3 years ago at the beginning of the trial, but it may still be running over there. It is a five year trial here. It is being run in Australia, America and Europe from what I understand.

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Hi Ozchrissy, thanks for your reply and I will do some more research on whether or not we have any trials here in the UK. I hope your operation was a success - I've heard the recovery time is much shorter.

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I had mine done 3 years ago, and it has been working like a little trouper since then. I have minimal mitral regurgitation and the valve is well seated. I was out of hospital within 5 days and my recovery has been good for the valve. I did have a bit of atrial enlargement and Afib in the early stages, but it is back to normal now. I do however have severe dysfunction and dilation of my left ventricle, so although the valve is working well, my heart is still pretty damaged. But I have had cardiomyopathy for nearly 20 years now, so the poor baby has done pretty well I reckon. I have had oesophageal cancer and chemo and also septicaemia which did the main damage to my mitral valve. I have a CRT-D as well, and that little angle has saved my life on numerous occasions. All I can say is that the valve improved my life, I was told to go home from another surgeon and Hospital but luckily my cardiologist knew the surgeon who was working on the transcatheter valve replacement and managed to get me in to see him. I am very lucky.

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It sounds like you have been through a tough time but pleased to hear your heart surgery was a success. I feel fortunate that I only the valve issue to undergo , so will keep plodding away trying to find out as much info on mini mitral as I possibly can. Everyone on this forum has been brilliantly helpful so thank you all very much for taking the time to reply 😘

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Yes, I just had it. May I ask if you are able to go back to work? I feel at a loss because I have no support system here in the states. All the surgeons said it will be way better than it was. It’s coming up on 3 weeks after surgery and I am trying to manage a small routine of doing one tiny thing, then resting.

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I asked about minimal invasive surgery when I was having mitral valve repair 3 years ago and the surgeons reply was it is equivalent to papering a hall,stairs and landing through a letter box,any way he thought the best chance of repair was through open heart due to the complex of the repair and to this day all seems to be holding up with no regurgitation

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Hi John-Butler, this has really made me smile! You must have too when he quoted this during your consultation. It’s good to hear your op went well - how long was your recovery?

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Hi I have had Mitral valve surgery, but open heart! I did have another issue also

However I wanted to go for minimally invasive and or robotic surgery.

My surgeon told me it depends on which leaflets are affected! The anterior leaflet is more difficult to repair and even more so if using minimally invasive and robotic procedures.

Posterior leaflet relatively easy.

Mine was very severe anterior leaflet leak.

He said robotic would be almost impossible, minimally invasive was possible but very difficult he would almost be working upside-down 🙃.

Plus he would not be able to repair the other issue.

Then if there was an issue or problems during surgery he would have to open the chest anyway so would have keyhole and sternotomy (open chest) sites!!

They also have to have two senior heart surgeons in theatre.

I for that reason switched and had open heart through sternotomy.

Didn't want to make the operation even more difficult.

Plus risks increased.

He also repaired the second issue.

All seems good now.

PS My surgeon is supposed to be one of the best most experienced heart and valve surgeons in the UK.

Experience in robotic, minimally invasive and sternotomy surgery with a 98%success rate in valve surgery.

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Hi, thanks for your reply and for the information on the leaflets. It would definitely appear that all will be decided when I have finished the tests and speak to a surgeon. I have checked my hospital letters and see that my leak is also the on anterior one 😬 the most difficult to repair so I need to prepare myself that mini-surgery may not be possible in my case. It will be good to get a surgeons opinion - particularly one who does both procedures so that I can hear the pros and cons if that’s possible where I live. Thanks for all your help and information and great to hear your surgery was a success 😊

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Just for further info the leak on my mitral valve is was in the A2 position.

Believe each leaflet is divided into sections which identifies the location of problem A1, A2, A3 mine was the part in middle where there was a large prolapse and broken cordeai tendonie (the part known as heart strings)

Hope info helps

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Thanks for letting me know 😊they haven’t given me this information so definitely a question to ask when I have my appointment.

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Hi BigT2013, I posted about a month ago trying to find out more about minimally invasive surgery. Still waiting to have angiogram and see a surgeon but I guess things slow down during the summer months. Waiting is difficult so I’m just reading through some of the replies and would be interested to know if your surgery was in Liverpool as I was reading articles on first robotic surgery in uk(not that I’m expecting this to be possible due to anterior leaflet). I have found out that the surgeon where I live does do both minI-mitral and OHS but everything I have read suggests always best to try and get this done by a surgeon/hospital who performs a high number of these. As you mentioned yours was trained in all of these areas I wondered if it was indeed Liverpool? Always helpful to talk to someone who has been through this so thanks in advance. How long did it take before you were felt able to carry on with your normal lifestyle? Or is this still ongoing?

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No it wasn't Liverpool.

It was Wolverhampton Heart and Lung Centre.

Reportedly where the first Robotic Mitral valve Surgery took place. With Da Vinci robot this was done in 2012.

So I don't know why Liverpool are claiming to be the first!!!! 🤔

If u have Internet search for robotic heart surgery Newcross Hospital.

t is possible if yours is Mitral Valve problem is the Anterior leaflet as I mentioned before it may not be possible to use robot or minimally invasive. It is a complex operation with the risk that if they hit any issues they may still have to open the chest fully and go through the breastbone.

Leaving the patient with two entry sites.

My surgeon was very experienced with a high success rate I checked 👍👌

I was fit with no symptoms but very severe leaking Mitral valve before surgery.

My fitness has increased by 20% since surgery I am way above average fitness for my age.

Minimal invasive /robotic surgery supposed to be recovered within 4-6 weeks.

The full open heart sternal precautions for at least 4-6 weeks within 12 weeks should be almost back to normal.

However I myself had an arythmia caused by rhythm disturbance caused by surgery back to normal now. That was a bit of a set back. Sorted by short stay in hospital.

Then I had an issue with breastbone healing but that's OK now. I'm back at work doing everything and more than before.

Fitter and stronger than ever.

Just at about 5 months from surgery.

However my job is physically demanding.

If office based or retired then u should easily be back to more or less normal by about 8 weeks.

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Thanks for your reply. I probably misread the info on Liverpool as it was more about the arrival of the robot at LHCH, and the programme they are now offering rather than being the first to perform it. I read the article on Newcross with interest and let’s hope many do get to receive this option in the future. I remain hopeful, but rather resigned, that this may not be possible for me so it was good to hear how well you have recovered - even with the setbacks you have experienced. It is very reassuring to hear that sternotomies do not necessarily mean a very prolonged recovery time. Always great to hear a success story so thank you.

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Yes and I believe it’s ur doctor’s choice.

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Thanks gal4god. Yes you could well be right!

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Hi sims 789 I have had both open heart and keyhole and the recovery on keyhole was so much quicker I had my aortic valve replaced both times much less painful, I highly recommend keyhole very highly best of luck

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Thanks Jlc1984. I would so much rather have the mini-mitral surgery if at all possible. Do you mind if I ask if you were able to get your key hole surgery with the NHS?

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I did.

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That’s good to know! Fingers crossed that my surgeon will recommend it - if I’m suitable

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Yes I got mine done on the nhs, I did not know I was having the mini so was a surprise when I woke, I knew something was different as was much more comfortable and mobile, the cut is a fraction smaller than original and they only break a few ribs rather than the sturnum,

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Thanks for the info Jlc1984 - I'll go with that any day!! Keeping everything crossed!

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I must be lucky, my side mini pried the ribs apart, not break them. Surgeon said I was very lucky on the minimal repair. But I am struggling with coping with feeling so weird. I assume recovery must come in stages, I was just wondering if there was like a reference chart for traditional v minimal and timelines.

Good luck. I wish that we had home care where some could drop by like they do in other countries.

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Hi, I had minimal invasive surgery for MV repair two and a half years ago on the NHS. I had severe MV regurgitation and became unwell rather suddenly. The heart surgery went well and they also repaired a small ASD at the same time - which is a hole in the heart. I now have a small scar on the right side of my chest. I had no pain although I felt rather tired and lethargic for a few days after my surgery. I soon felt amazingly well and was able to drive my car within the month. Now I have a normal life and I am back working I can’t thank the NHS enough I am a qualified Nurse with many years experience. I hope this helps and good luck with your surgery.

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Hi, thank you so much for your reply. It’s very reassuring to hear from those who have positive experiences from this type of surgery. I have recently been offered the uk mini mitral trial whereby you have a 50% chance of minimally invasive or sternotomy, however felt this wasn’t for me as I really would prefer the former due to the shorter recovery time. I am now due to see a consultant at the end of this month to discuss my options so very much hope to get accepted for the minimally invasive (without the risk of being randomly chosen via the trial which could of course go either way). I would be very interested to know if you had your procedure done locally or whether you opted to go to a different hospital/surgeon through patient choice? Many thanks and appreciate hearing from you :)

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Hi, I had a choice of two hospitals and I made my own decision also I asked to see a certain surgeon who was familiar with MInimally Invasive surgery. At my Consultation I was told if any problems during surgery I would end up having a sternotomy.

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