"Limited Access" Valve Surgery (Thoracoscopic and Robotic)
Heartport, minimally invasive, and port-access approaches can be collectively viewed as “limited access” approaches to heart valve surgery. This approach does away with the use of sternotomy (cutting of the breastbone of the chest), and instead uses a strategically placed mini-incision that allows access to a particular valve in the heart chambers.
Different incisions have been used for the aortic valve (such as the traditional Chamberlain incision), while a sub-mammary incision is used for the mitral valve. Both incisions are located on the right side of the patient’s chest and are usually about 2 to 3 inches in length. This approach allows the use of cardiopulmonary (heart-lung) bypass with cannulation (fitting of a channeling device) placed through the femoral vessels (the main artery near the groin area supplying the thigh and leg).
The clinical benefits include:
An intact sternum that may lead to quicker recovery.
A clear cosmetic advantage that appears to be more desirable to the female patients.
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The SUNY Downstate Medical Center staff, including the faculty surgeons, the anesthesiologists, the perfusion team, and the operating room nurses, is being trained to prepare for this level of sophistication. The team has gone out once to an off-site training program. The special equipment needed for this surgical technique has been gathered. We plan for the Downstate Cardiac Surgery Program to provide this service on a consistent basis. Once the initial phase of this valve program becomes successful, we intend to progress to the next level of robotic assisted mitral valve repairs. SUNY Downstate Medical Center has acquired the DaVince Robotic system in 2007 and it is being utilized successfully in urology. We are in discussion with the industry to train the cardiac staff. We plan to start with robotic assisted MID-CAB (single vessel coronary artery bypass with left internal mammary artery to left anterior descending artery) through a key-hole incision. This will allow the team to develop proficiency in the system before we will embark on the more advance Robotic mitral valve repairs. |