Rare cardiac port access surgery performed at Sunnybrook

Surgeons at Sunnybrook’s Schulich Heart Centre have successfully performed their first port access surgery to repair a faulty mitral valve. The highly technical video-assisted procedure has only been performed at three other centres in Canada to date.

The minimally invasive surgery is carried out through a few small incisions, or “ports” in the groin, neck and chest – eliminating the need to split the patient’s breastbone.

“Although we have successfully performed mitral valve surgery for years by splitting the breast bone to access the heart, this new procedure allows us to reach the heart through a small incision between the ribs.” says Dr. Gideon Cohen, Cardiovascular Surgeon at the Schulich Heart Centre.

A properly functioning mitral valve will open to allow blood to flow into the heart’s main pumping chamber (left ventricle) and then close to keep blood from leaking back into the lungs.

Patients requiring mitral valve surgery either have a leaking or narrowed valve, both of which may cause blood to flow in the wrong direction, straining the heart and lungs.

Some people are born with a faulty valve, while others can develop it over time. Both abnormalities can leave patients short of breath, and can ultimately lead to heart failure and/or death if the valve is not repaired or replaced in a timely fashion.

To repair or replace a faulty mitral valve using the port access technique, surgeons make use of special telescopic instruments through a five-centimeter incision in the right chest. A camera is threaded through another small incision, allowing the surgeon to view the entire procedure on a large video monitor.

During the surgery, the patient is connected to a heart-lung bypass machine via another incision in the groin. The machine circulates oxygen-filled blood throughout the body while the operation is being performed, allowing the surgeon to work on an open, stopped heart.

“The results to date have been truly remarkable,” says Dr. Cohen, also an Associate Professor at the University of Toronto. “Patients have enjoyed shorter hospital stays, less pain, and an earlier return to normal activities. The cosmetic benefits have been particularly impressive, with many patients having barely noticeable incisions beneath the right breast,” he adds.