Watch Cardiac Surgeon, Chris Cook, M.D., skillfully perform a mitral valve repair surgery utilizing a minimally invasive approach.
Hi, my name is Chris Cook. I'm a cardiac surgeon at Terra Heart Hospital in Norfolk, Virginia. And today I want to talk to you a little bit about microvalve disease and minimally invasive cardiac surgery. Uh Many people have microvalve disease. It's very common and one of the common things that happen is that their valve can begin to leak. We've known for many years that people who undergo valve surgery have options of either replacing or repairing their valve and repairing their valve is far superior. Uh if that can be done uh for many reasons uh that uh I discussed but mostly it will obviate the need for you to take uh anticoagulation lifelong and by and large uh durable repairs can essentially be a curative operation. Nowadays, we have the option to spare uh the sternal incision and actually do these as a minimally invasive approach through a smaller incision in the side. And uh I will walk you through one of the cases and show you uh some of the details of that operation. Ok. Here we are at the start of a case. This is a young gentleman who presented with shortness of breath uh secondary to a micro valve prolapse. He's a very active person and wanted to have a minimally invasive approach. You see that this standard incision that we make is a much smaller incision and we were able to gain access uh to the heart uh by making a uh an incision just beneath the right breast. Uh We are able to operate through there with minimal invasive instruments and uh we can go on the heart lung machine uh by using peripheral cannulation techniques. Uh As you see that we're doing here, this is the mitr valve. And you can see within the metal grasper, there's a portion of the valve that has been ruptured. Uh This is very common with microvalve disease and it results in a significant leak. We're able to use minimally invasive single shafted instruments to reach through a smaller incision uh to do the repair. And you can see that uh in, in this portion, I have a small shafted instruments where I am uh placing sutures uh to repair the mit valve once we uh gain uh good visualization uh and uh we uh commence with the repair. Uh We can actually uh show the entire team as we're doing here uh with a uh camera such that uh we can um educate uh team members and demonstrate various uh portions of the case. Uh Here, you can see that we're actually testing the valve uh that we have repaired by injecting saline behind uh the valve. This is a supportive ring uh that is very common uh in heart surgery. Uh Once we do the primary sutra repair of the valve, uh we insert uh one of these commercially available rings around the valve to sort of support it. Uh So this is not a valve replacement, this is just merely an adjunct as part of the repair. The patient still has their own native valve leaflet tissue. You can see here that the su that we've put through uh the outside of the valve, an area called the annuus where we implant this ring, we pass those sutures through the ring and now we're able to uh seat the valve in place. Uh what we call a parachute technique where these uh sutures are parachuted um through that uh prosthesis as it's then seated. We're now using a uh special device that helps facilitate minimally invasive suit uh where we don't have to tie those knots by hand, but we simply pass the sutures through this uh device that uh quickly crimps and cuts the sutures for us. You can see that it does that rather efficiently. Here is the final product. The repaired valve. You can see that we have uh saline injected behind this valve and it is completely competent and there's no fluid leaking back at the camera. And that is a completed mit valve repair done minimally basically
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