Open & Robotic Heart Valve Surgery

There are several forms of valve reconstruction, which include:

• Annuloplasty: To tighten or strengthen the opening of the valve (annulus), a specialized ring-like device is placed around the valve.
• Reshaping: To ensure the valve can properly open and close, excess tissue is removed from the leaflets/cusps of the valve so they tightly close.
• Reconnecting: When there are gaps or tears in the valve leaflets/cusps, they are reconnected to allow the valve to properly open and close.
• Structural Cord Repair: The leaflets/cusps of each valve are supported by tiny cords and muscles, which work together to open and close the valve. Replacing or shortening the cords allow the valve to open and close properly.
• Commissurotomy: As a result of valve stenosis, the leaflets/cusps of the valve may become thickened and stuck, preventing the valve from properly functioning. Removing excess tissue allows the leaflets to fully open and close.

When disease or damage is extensive, a valve replacement may be the safest and most effective option. Utilizing only the latest valve replacement options, a mechanical valve or biological tissue valve may be used, both of which offer notable advantages.

While valvular heart diseases are not as common as other types of heart disease, it is estimated that nearly 3 percent of US adults has some form of valvular disease and the risk of developing it increases with age.

To determine if open valve surgery is the best treatment option for a damaged or diseased valve, there are a variety of factors that may be considered. In addition to the overall health of the patient and their medical history, the surgeon will carefully evaluate key characteristics of their condition, including:

• Whether it’s causing symptoms that interfere with or affect quality of life
• The degree of damage or disease in the valve
• The presence of other cardiothoracic damage/disease
• Whether the patient has undergone past cardiothoracic procedures

There are many factors that may determine if minimally-invasive cardiac surgery is the best treatment option. In addition to the specific type and severity of the valvular disease, the patient’s age and their health history are important considerations. Most patients are a great candidate for robotic heart surgery, including those who are elderly or who carry higher risks, but that is a decision that your cardiothoracic surgeon will help you and your family make.

With an innovative approach to performing valve repair and reconstruction, robotic heart surgery offers several benefits as compared to traditional open surgery, such as:

• Smaller incisions (8mm – 2 inches vs. 6 – 12 inches)
• Little to no bone spreading (only soft tissue trauma)
• Shorter hospital stay, faster recovery and returning to normal activities more quickly
• Less pain during recovery
• Minimal scarring at the incision site(s)
• Decreased blood loss (requiring the need for transfusions)
• Decreased risk of infection
• At times, these surgeries can also be performed off-pump, which gives patients who are particularly high risk more options.

As with all types of surgery, robotic surgery does have limited risk. With a cardiothoracic surgeon and collaborative team of experts that fully understand all possible complications and risks related to the procedure, they actively take steps to prevent and avoid risks during and after surgery. Unlike traditional surgery, robotic surgery does not have any risks associated with a sternotomy and it has a lower risk of excess bleeding (requiring transfusions) and lower infection risk.

Robotic heart valve surgery has risks similar to open heart surgery, including:

• Bleeding/Blood clots (stroke/heart attack)
• Infection
• Pneumonia
• Pancreatitis
• Kidney failure
• Heart rhythm abnormalities

Following valve surgery, you will be taken to Georgia Heart Institute’s state-of-the-art cardiovascular intensive care unit (CVICU), the Ronnie Green Heart Center. There you will be closely monitored by a dedicated team of specialists to ensure that all vitals and readings are stable and healthy.

At first, you will likely be on a ventilator to allow the body to heal and to support breathing during the early stages of recovery, but you will then transition to self-sustained breathing. During this time, you may also notice chest discomfort and soreness, which is normal following surgery. Our cardiac surgical and recovery teams will help to provide guidance and support on how to perform breathing exercises that ease pain and minimize risk of pneumonia.

As you continue to heal, you will receive medications, therapies and assistance to support your recovery. In addition to the CVICU, you will receive care in the Cardiac Care Unit and from the Cardiopulmonary Rehabilitation team, all to keep you progressing through each stage of post-surgical recovery and back home.

All patients should expect a 1 – 5 day hospital stay, with robotic heart surgery patients typically discharging sooner. After you return home, robotic heart surgery patients will experience a fuller recovery in 1 – 2 weeks, while open heart surgery patients should expect a recovery of 2 – 5 weeks.