Small Incisions Make Heart Valve Sur...(percent at one year and 85.6 percent at ...),Health

One major reason for the high success rate is that the minimally invasive technique does not require the removal of scar tissue that almost always forms after cardiac surgery, Casselman said.

People in the United States seeking this particular kind of minimally invasive heart valve surgery might have a long search, he said. "It is known in the United States but not widely available," Casselman said.

Robotic surgery tends to be favored in the United States for mitral valve procedures, he said. "We avoid the extra cost of the robot," Casselman said. "Robotic surgery gives good results but at a much higher cost."

In the United States, "there are multiple approaches to use smaller and smaller incisions for these operations," said Dr. Irving Kron, chairman of the department of surgery at the University of Virginia, and a spokesman for the American Heart Association.

"Many surgeons tend to use robotics right now, but it is not routine in our practice," Kron said. "The robot doesn't give you a direct feeling of what you are doing, and that troubles us."

There is no single guide to the best minimally invasive procedure for a given patient, Kron said. "The surgeon and the patient have to weigh the situation," he said. "A lot has to do with whether the cardiologist has a relationship with someone who knows a surgical technique."

And while minimally invasive surgery generally is preferable for heart operations, its drawback is that the procedure tends to be longer than conventional surgery in which the chest is opened, which means more time on the heart-lung machine, Kron said.

"If the operation can be done quickly, that is the best," he said. "If you spend twice as long on the heart-lung machine, there may be no gain."

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A guide to heart valve surgery is provided by the