Minimally invasive heart valve surgeries are surgical techniques that use smaller incisions, compared to traditional open-heart surgery, when repairing or replacing a defective heart valve. The actual surgical repair is the same in the minimally invasive and the traditional procedures. However, minimally invasive surgery involves a much smaller incision to enter the chest and then the heart. There is also a difference in how long the surgeries take, with the minimal procedures usually taking longer because of their higher level of complexity.

The types of valvular heart disease that can be repaired by minimally invasive surgery include valves that have narrowed (stenosis) or valves that do not close properly and allow blood to leak back in the wrong direction (regurgitation).

Most commonly, minimally invasive techniques for valve surgery are performed on one of the following valves:

• Mitral valve. Located between the upper-left chamber (left atrium) and the lower-left chamber (left ventricle) of the heart.
  
  
• Aortic valve. Located between the left ventricle and the aorta (the main artery carrying oxygen-rich blood from the heart to the rest of the body).

All minimally invasive heart valve surgeries rely on cardiopulmonary bypass with a heart-lung machine. By contrast, minimally invasive bypass surgery can be performed with or without bypass. This means that minimally invasive valve surgery carries all the risks associated with the heart-lung machine (e.g., blood clots, confusion). However, by relying on smaller incisions, minimally invasive valve surgery offers a few advantages, including:

• Limited blood loss during surgery
• Reduced hospitalization
• Reduced chance of infection from large incisions
• Less scarring

Because it is more complicated than standard open-heart surgery, not all patients are suitable candidates for this surgical technique. People with conditions such as “hardening of the arteries” (atherosclerosis) or obesity (body mass index greater than 30) may not be eligible. Additionally, the minimally invasive technique is generally best for a single, isolated valve disorder instead of multiple forms of valvular heart disease, and high-risk elderly patients may not be suitable candidates.

Minimally invasive techniques in heart surgery have been in full use only since the late 1990s, and different forms are still being tested. For example, one experimental procedure, known as percutaneous heart valve implantation, allows a physician to replace a heart valve using a balloon catheter and a stent. The stent is inserted into the femoral artery through a puncture in the skin in the groin. The replacement valve is then threaded through the artery to the heart via the stent. Once in the heart, the stent is expanded, allowing the physician to implant the replacement valve. Early research has shown the procedure may be a good option for patients in need of an aortic valve replacement who are not able to undergo open-heart surgery because of poor overall health or life-threatening conditions.

Another strategy involves a voice-activated robot, which performs much of the operation under the direction of a surgeon who is viewing, and performing, the operation through an endoscope (a slim optical tube positioned in the chest cavity). The robot’s “hands” are smaller than human hands and require a smaller incision. Robotic visualization techniques are considered to be safe and reliable, causing less pain to the patient, less surgical trauma and a shortened recovery time. Robotically assisted surgery has been used for mitral valve repairs with good results. It is available only in limited centers around the world.