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Frequently Asked Questions

How do you reach the valve if you aren’t going through the breast bone?

I make a small incision on the right side of the chest and go in between the ribs, therefore avoiding the need to cut any bone. With long instruments and a camera, I am able to perform the operation. In order to improve visualization while still keeping the incision small, the cannulas (tubes) used to connect the cardiopulmonary bypass (heart-lung) machine are placed through a tiny incision in the groin and a small nick in the neck

Are you less likely to repair a valve if you approach it minimally invasively?

No, the procedure inside the heart is the same whether through the breast bone (sternotomy) or through a small chest incision (minithoracotomy). In fact, the visualization of the valve can be superior through a minithoracotomy because of the orientation of the valve. With a minithoracotomy, the valve sits facing the point of entry. As well, the high definition internal camera allows us to zoom in and look at those areas that are harder to see with a sternotomy. The specialized thin, long-shafted instruments allow for better reach and maneuverability.

Is Barlow’s mitral regurgitation repairable?

Barlow’s valves have excessive tissue on both leaflets which causes billowing of the leaflets above the plane of the valve. This can cause multisegment leaks which can be more challenging to repair. That being said, we repair a large number of Barlow’s valves. Most Barlow’s valve patients require only isolated mitral valve surgery, making them ideal for a minimally invasive mitral valve surgery approach.

What is the usual length of stay for a minimally invasive mitral valve surgery?

Most patients will go home 4 days after their minimally invasive mitral valve surgery.

What other heart surgeries can you do through a small chest incision?

There are a number of heart structures that can be reached through a minimally invasive surgical approach. Through a small chest incision (minithoracotomy), I have completed tricuspid valve repairs/replacements, repair of atrial septal defects, arrhythmia surgery (Maze procedure), removal of cardiac masses/tumours. Indeed, any combination of these procedures, including a mitral valve procedure, can be done in the same operation.

How is the MitraClip procedure performed?

During the MitraClip procedure, you are under a general anesthetic so you are sleeping comfortably and feel no pain during the procedure. A breathing tube will be placed for the procedure, and will be removed before you are completely awake. A catheter (long flexible tube) in placed into your a vein in your groin (femoral vein). It is through this catheter that the MitraClip delivery device steers the MitraClip to the mitral valve. The MitraClip crosses the right upper chamber of the heart (right atrium), into the left upper chamber (left atrium) through a small hole. Transesophageal echocardiography (ultrasound) and fluoroscopy (X-ray) are used to position the MitraClip and secure the leaflets together at the site of the leak. One or more MitraClips can be inserted during the procedure. The number of MitraClips used is based on the number needed to adequately reduce the leak while still allowing the valve to open for forward flow. Once the delivery device and catheter are removed, a small stitch is placed over the groin site needle puncture. This stitch is removed the next day.

How long does the MitraClip procedure take?

The entire MitraClip procedure usually takes 2-3 hours.

What is the usual length of stay after the MitraClip procedure?

Most of our MitraClip patients go home the next day following the procedure.

What is recovery like after the MitraClip procedure?

After you are awake, you will be asked to lie flat with your leg straight for a few hours post MitraClip procedure. After that, you will be able to sit up at first, then get up and walk as tolerated. The next day you will be assessed by members of the MitraClip Team, including a physician, the MitraClip Nurse Practitioner and Physiotherapist. The groin site will be accessed and the stitch removed. You will also undergo a transthoracic echocardiogram (ultrasound of the heart) to assess the mitral valve and the MitraClip. Most patients will then go home if ready.

What to expect after discharge for hospital following the MitraClip procedure?

It is normal for the groin site to have some bruising and/or a small lump after the procedure. Seek medical attention if the site has a lump that is increasing in size, or there is increasing redness, warmth, pain or discharge at the site.

What kind of physical limitations will I have as I recover from the MitraClip procedure?

No pushing, pulling or lifting greater than 10 pounds for the first 5 days after the MitraClip procedure. You can climb stairs but take it slow for the first 5 days.

Who is the best mitral valve surgeon?

When deciding on the best mitral valve surgeon for you, there are a number of factors to consider. The mitral valve is a complex structure and not all cardiac surgeons feel comfortable doing complex repairs. Experience in complex mitral valve surgery might therefore be a consideration if you want the best chance of repair. Are you a candidate for a noninvasive options such as the MitraClip? Then a centre with a MitraClip Heart Team can help assess whether the MitraClip is right for you. If you are not a MitraClip candidate and need surgery, would you like to be considered for a less invasive surgical option which avoids cutting the breast bone? Then choosing a centre that has an established Minimally Invasive Mitral Valve Program might be an important factor in making your decision. Whomever you choose as the best mitral valve surgeon for you, it is important that you feel comfortable that they have provided you with the information you need to make an informed decision and given you access to options that best suit your mitral needs.