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Small Incisions Make Heart Valve Surgery Safer
Date:9/10/2007

Death risk lowered for those who had undergone previous heart surgery, Belgian study finds

MONDAY, Sept. 10 (HealthDay News) -- Heart valve surgery using only two tiny openings significantly reduces the risk of death for people who have had previous cardiac surgery, Belgian surgeons report.

"We were astonished that the reduction in risk was much more than we expected," said Dr. Filip P. Casselman, a staff surgeon at the OLV Clinic in Aalst and lead author of a report in a cardiovascular surgery supplement of the Sept. 11 issue of Circulation.

The procedure described in that report cannot be used in all heart valve operations and is not widely available in the United States, Casselman noted. But it is an outstanding example of how much safer minimally invasive surgery can be for high-risk patients, he said. In the study, the risk of dying during or immediately after the operation went from 16 percent to 3.8 percent, he noted.

In the procedure, a tiny camera and light are inserted into the chest through an incision a third of an inch long in the right armpit. Miniature surgical instruments are inserted through a two-inch hole below the right nipple. The surgeon sees an image of the heart on a computer screen and uses "joy sticks" to move the instruments.

The procedure can be used for surgery on the mitral and tricuspid valves, Casselman said, but not on the aortic valve. "For that, we have an alternative minimally invasive procedure," he added.

The mitral valve controls flow of blood from the upper left chamber of the heart to the lower left chamber. The tricuspid valve controls blood flow between the two right chambers of the heart. The aortic valve controls blood flow from the left ventricle, the main pumping chamber of the heart.

The report described results of the technique in operations on 80 patients who had at least one previous cardiac operation. Overall survival was 93.6
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