Anyone who has ever had traditional open-heart surgery knows the experience is no walk in the park. UI Heart and Vascular Center has offered minimally invasive heart surgery to a select group of patients, but recently added another approach that allows more patients to be candidates for this type of open heart surgery.

R. Saeid Farivar, MD, PhD, director of UI Heart and Vascular Center's minimally invasive cardiac surgery, talks about the new open-heart procedure:

Who qualifies for the new minimally invasive open heart procedure at UI Heart and Vascular Center?

The good news is that anyone who needs a valve repair or replacement or an ascending aortic procedure is a candidate—there are no age or size cutoffs. An aortic or mitral valve repair or replacement, a reoperative valve procedure (reoperative meaning after coronary artery bypass), or an ascending aortic aneurism repair, are all candidates for minimally invasive procedure.

Who is likely to receive this procedure?

The typical patient is young, concerned about his or her incision site, and needs a single valve repaired, such as an aortic or mitral valve. She might be interested in wearing a low-cut blouse without having a visible scar, or he might be interested in wearing a V-neck sweater without a scar. He or she may also be interested in getting back to work sooner. I've had some farmers who've had this procedure who really wanted to get back to work quickly. I found that very interesting because on the East Coast when I've performed these procedures, it's more of a cosmetic issue. Here in Iowa it seems to be more of a functional issue and I find that very interesting.

How is this procedure different from other minimally invasive open heart procedures?

The biggest difference is in the incision. Instead of a full incision which is about 10 inches long up and down your sternum, we have a small two-inch incision, and that gives you a limited view. You need special instrumentation, special retractors, special tubing, special pick-ups, etc. We perform a mini-sternotomy and t-off a small piece of the sternum, keeping the sternum more in tact. We use a special canula to put the heart on a bypass circuit. The beauty of this procedure is it is as safe and as effective as the full sternotomy which has really been the gold standard. This has been championed at institutions such as the Brigham & Women's Hospital and Harvard Medical School where I came from, as well as at the Cleveland Clinic.

Explain how the UI Heart and Vascular Center team works in this type of open heart procedure?

Cardiac surgery is one of the most coordinated surgeries in history. It's really like a symphony and each team has its own part. The nurses help do the pre-op testing that helps get the patient ready. At the Day of Surgery, anesthesiologists bring the patients into the OR and put them comfortably to sleep and place all the monitoring lines. The OR nurses assist in this delicate operation. The perfusionists work with me to place the patient on bypass. The PAs and residents help me to perform the procedure. Afterwards, the ICU staff and I are responsible for the post-op care of these patients. This makes for a very coordinated experience.

What are the benefits to the patients who have this new minimally invasive open heart procedure?

We've alluded to a few of the benefits. There is:

• A smaller scar, about a third the size of a typical scar
• Reduced pain
• More sternal stability
• Ability to go back to your activities sooner, such as driving or work—you can generally get back to work or driving within three weeks
• Less blood usage because you violate less of the sternum in the procedure

Everything is minimized in this procedure, except for the outcomes.

Do people need to be referred to the UI Heart and Vascular Center, or could they make an appointment to be evaluated?

They can come in either way. They can be referred to our clinic by their primary care provider or cardiologist, or they can make an appointment if they suspect that they need valve surgery. Most you're not sure or had a relative that had a valve procedure and worried you also might need one.

This type of surgery—minimally invasive valve repair—is done by very few centers in the U.S., so if you've got a mitral or aortic valve that needs a repair and you'd like it done minimally invasively, by all means call UI Health Access, 319-384-8442 or 800-777-8442.

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R. Saeid Farivar, MD, PhD

UI Heart and Vascular Center