Endoscopic cardiac surgery for mitral and aortic valves

Less invasive, minimal access surgical technique as an alternative for open heart surgery (sternotomy). The technique provides more options for patients and can help them achieve a better quality of life more quickly, along with less pain and scarring.

Find an Endoscopic cardiac surgery consultant

Endoscopic cardiac surgery is a minimally invasive procedure to treat a wide variety of heart valve conditions, coronary artery disease, PFO and Atrial Fibrillation. Due to a smaller incision, it allows for less scarring, faster recovery time and less complications for patients. The procedure involves high-definition 3D cameras and screens to aid collaboration for greater accuracy and quality.

The Harley Street Clinic, part of HCA UK, is the only private hospital in the UK that offers totally endoscopic valve repair for the mitral and aortic valves and is leading the way in the endoscopic cardiac surgical field.

The table below outlines the main differences between open-heart surgery (a sternotomy) compared to endoscopic surgery:

Open-heart surgery (sternotomy)	Endoscopic heart surgery
15-20cm incision	2.5cm incision
Scarring down the centre of the chest	Minimal or non-existent scarring
4–6-month recovery time	3-week recovery time
Relies on direct vision	Multiple 3D screens for better accuracy
Post-surgery back and chest pain	Minimal discomfort post-surgery

Examples of scarring from standard heart surgery and endoscopic heart surgery

Sternotomy post-surgery scar

Endoscopic surgery scar

Speaking about the new mitris resilia mitral valve we now offer as part of our endoscopic cardiac procedures, Mr Bahrami said:

“This procedure is life changing for the patient. Younger patients who usually receive a metallic valve will experience some troublesome noise from the valve. The resilia valve is made from tissue and therefore not noisy, it also offers less risk of infection and avoids the need for a repeat operation as the valve will last up to 20-30 years. The durability is almost 10 times better. The Harley Street Clinic is the only private hospital in the UK that offers totally endoscopic valve repair for the mitral and aortic valves and is leading the way in the endoscopic cardiac surgical field.”

What procedures can be performed with endoscopic cardiac surgery?

Coronary artery bypass / MIDCAB
Mitral valve repair/replacement
Aortic valve repair/replacement
Tricuspid valve repair/replacement
Left atrial appendage occlusion and atrial fibrillation ablation
Patent foramen ovale (PFO) closure
Atrial septal defect closure

Conditions we treat

Mitral valve disease
Aortic valve disease
Tricuspid valve disease
Coronary artery disease
Patent foremen ovale (PFO) - hole in the heart
Atrial fibrillation – irregular heartbeat

What you can expect

Initial appointment

You will discuss your medical history and symptoms with the consultant, and they will arrange imaging or diagnostic tests, and involve allied specialists if required (e.g. imaging cardiologists, interventional cardiologists, radiologists, pre-assessment team and clinical nurse specialists).

Investigations and diagnosis

Most of the time, you will complete your cardiac invasive and non-invasive assessments and imaging during the same week and receive your results within 48 hours. Tests include:

Echocardiogram (Transthoracic/Transoesophageal)
Angiogram
CT with 3D reconstruction
Chest x-ray
Blood tests

Your case will be presented to the specialised dedicated cardiac multidisciplinary team, who hold regular meetings to ensure the highest level of best medical practice based on GMC guidelines.

Treatment

Having endoscopic surgery means you’ll be under general anaesthetic for around 3-4 hours. A small incision of 2.5cm will be made and the surgery will be carried out using cutting-edge technology including 4K 3D camera system with robotic arm and specific endoscopic instruments, which allows a higher level of precision and better quality of repair. For men the incision is made at the peri-areola area or on the right side of the chest; for women, it’s made at the peri-areola or underneath the chest. Once surgery is complete, small stitches will be made at the incision site to ensure minimal scarring.

Aftercare

As a patient you will be supported throughout your journey by our one-to-one dedicated cardiac clinical nurse specialist. Immediately post-surgery you will be monitored in the intensive care unit for up to 2 days before moving to the cardiac ward of the hospital, where you will stay for around 3 days to recover. Our cardiac CNS will conduct a post discharge call within 1-3 weeks and update your consultant (you can contact them at any time – given a number). The consultant will also see you 2 weeks post-surgery at one of their NHS or private outpatient clinics.

Examples of minimal scarring from endoscopic cardiac surgery

Minimal scarring female.jpg

Example of scarring with endoscopic keyhole heart surgery on female (peri-areola)

Endoscopic Cardiac surgery minimal scarring male

Example of scarring with endoscopic keyhole heart surgery on male (right side of chest)

Why The Harley Street Clinic?

✓ Specialists in endoscopic/minimally invasive heart surgery – The Harley Street Clinic was the first private hospital to perform MITRIS RESILIA valve replacement (aortic and mitral), endoscopic mitral and tricuspid valve surgery.

✓ We work with the leading consultant in endoscopic cardiac surgery, Mr Toufan Bahrami who has performed over 1,500 minimal access cardiac surgeries.

✓ The Harley Street Clinic performed over 100 minimally invasive/endoscopic cardiac procedures in the last year.

✓ We are the only private hospital offering endoscopic heart surgery in the UK.

✓ We invest in market leading, innovative technology to ensure the best patient outcomes.

✓ A personalised approach to care for every patient, considering their individual anatomy, surgical preferences and lifestyle.

✓ Current waiting times for endoscopic procedures are at least 9 months – at The Harley Street Clinic you can receive your procedure in 2-3 weeks.

Mr Toufan Bahrami, Consultant Cardiac Surgeon

Toufan Bahrami has 23 years of experience in minimal access surgery. He’s performed more than 1,500 minimally invasive cardiac procedures, averaging 6-8 per week across men and women in the last year. He is responsible for performing the first private hospital resilia mitral valve replacement through an endoscopic approach at The Harley Street Clinic.

He is passionate about providing a better quality of surgery, performed through sternotomy, using a smaller incision and without opening the breastbone. His passion is endoscopic cardiac surgery, or ‘totally endoscopic’ procedures, which involve a 2.5cm incision (compared to other heart surgeries of up to 20cm) and 3D cameras and screens for enhanced accuracy and better results.

He treats patients at several of our HCA Healthcare UK hospitals including The Wellington Hospital, London Bridge Hospital and The Harley Street Clinic, the latter of which is the only hospital to offer private endoscopic heart surgery.

Q & A

Who’s involved in my endoscopic cardiac patient journey?

The cardiac surgeon is ultimately responsible for the patients care. The best course of treatment for each patient is decided in the monthly dedicated MDT meeting, consisting of your surgeon, an imaging cardiologist, radiologist, interventional cardiologist, theatre nurse, perfusionist and anaesthetist.

What’s Mr Toufan Bahrami’s success rate with minimally invasive procedures?

100% of the degenerative mitral valves are repaired

0% conversion to sternotomy

Over 99% well-functioning, competent valves at 10 years post-surgery

How many days do I spend in the hospital?

4-5 days. Patients are discharged once they’ve been supervised and able to walk, go up and down stairs and shower.

Is it painful?

During the procedure you will be put under general anaesthetic. Post-procedure, you will have a ‘local block’ in the form of a catheter linked to the incision which injects pain relief and is removed on day three. Post-discharge there may be some discomfort for a few days, managed by pain medication.

When can I drive?

Usually within 3 weeks

When can I fly?

4 weeks after surgery you should be fit to fly

How do I feel after surgery?

At two weeks a patient should be able to do up to 10,000 steps a day. Within four weeks patients have reported being active again and feeling positive, with minimal scarring when compared to a standard procedure.

What are the potential complications?

Post-surgery a patient could be diagnosed with atrial fibrillation, usually treated by medication. Another complication could be plural effusion (small amount of water between the lung and chest wall) which is usually treated with diuretics (urinary tablets).

Due to a smaller incision, there is far less chance of infection compared to surgeries with larger incisions such as a sternotomy, as well as no risk of a sternal disjunction. With the surgery live on-screen for theatre staff to observe, any issues during surgery can be picked up and acted on a lot faster.

What about my tricuspid valve and atrial fibrillation?

Tricuspid and ablation for atrial fibrillation can be performed at the same time as endoscopic mitral valve surgery. In fact, 40% of our patients have multiple valve procedures at the same time.