Dr. Neelan Doolabh repairs a mitral valve using a minimally invasive approach (mini-thoracotomy) at UT Southwestern Medical Center
the beauty of this operation is that no bones are broken. We simply work between the ribs as opposed to dividing the patient's chest. To accomplish what we need. Search operation begins by making a 4 to 5 centimeter incision in the right chest. We're gonna put in a soft tissue retractor. Once we get exposure to the chest, it's okay to ventilate please. We turn our attention to the femoral arteries in the leg in order to place the patient on cardiopulmonary bypass. We're placing the wire into the superior vena cava using the echo to guide us. We place the venus cannula in. Now we'll place the arterial cannula to complete the circuit for the heart lung machine. Now that we're on the heart lung machine, the lungs are no longer needed so we can move them out of the way and then we'll open up the pericardium here, which is the lining around the heart. Mm. We play a variety of pericardial sutures just to gain further exposure. We're gonna eventually require drainage tubes. So we'll make that hole now and we'll utilize that for some of the things that we need. Now we're making room for aortic cross clamp. Okay, hello, normal Cameron. Start cooling please. Okay, super low flow please. We're gonna take this aortic cross clamp and cross clamp the aorta to arrest the heart. So this generally takes a few minutes so the heart should stop here fairly soon and there it goes will allow him to shrink down the heart because the heart is full of some of that medication and as it shrinks down. Then we can begin our operation. We're going to actually open the left atrium and get access to the mitral valve itself. Now we'll just go and examine the valve that looks like it's in pretty good shape so it looks today. All we need to do is put a titanium band around this valve. But you can see we get excellent exposure of what we're trying to do prior to the patient's operation. We take a careful look at his imaging to decide whether his valve is repairable or requires replacement. The final determination is made at the time of the operation. When we get a good look at the valve and determine the quality of the valve tissue itself. This ring will stay in there forever. We do all the work on the outside but you can see there's really no need to open somebody's entire chest to do this, Cameron. Why don't you go ahead and start rewarming c. 0. 2 10 Please. At this point we inject sailing directly through the valve, repair itself to pressurize the ventricle to ensure that there are no leaks around the valve. So now we just close up the heart and we are done surprisingly through the mini thoracotomy approach. We get a direct view of the mitral valve which is superior to the view that we can achieve when we do the traditional operation. This little blue line is a pacing wire that will help us regulate the heart rhythm after surgery. Which is pretty standard. Now we go and put a needle back into the aorta from which we're gonna aspirate any air that's remaining inside the heart. Now we'll remove the air to cross, clamp cramps off flow back up please. Okay, so he's got a heart rhythm back already. So Cameron, would you fill up the heart a little bit please? We're gonna look and see, make sure that the repair looks adequate. You see the mitral valve there at 12 o'clock in the middle of that triangle and you see it open and we don't see any rainbow color going up so it looks like it's not leaking, which is good to get off the heart lung machine will have to restart the lungs and all that stuff. So his own lungs are doing some work. Cameron flow back up please. We minimize the support of the cardiopulmonary bypass machine. We make sure that the heart can sustain and maintain on its own. He's looking very stable and he's looking very good currently. So we feel very comfortable of taking this stuff out. There's no rib fracture or anything. We just go completely in between May I have antibiotics and then I'll take pain medicine please. So less than an hour for the operation, an hour and a half for the whole heart lung machine and then it'll take us half an hour to close within two hours will be done. Generally takes somewhere between four and 6 hours to do this operation. As you've seen here, we've accomplished this in less than an hour, meaning they're not on the heart lung machine for a prolonged period of time. They're under anesthesia. Less. This guy within the next hour will be awake and talking to us. So it's a very quick and efficient way of doing the operation.