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Leonard Y. Lee, M.D., program director of cardiac surgery, examines a patient.

New York Methodist Hospital now offers a minimally invasive alternative to traditional mitral valve surgery. Former necessary procedures, such as dividing the breast bone in order to reach the heart, may no longer be needed to treat this serious heart condition. With the alternative procedure, only a small four-inch incision is required to repair the mitral valve when it ceases to function properly. Although the minimally invasive procedure is a variety of open-heart surgery, it is much easier on the body and yields the same results as traditional open-heart surgery. "Minimally invasive mitral valve surgery is relatively new. We are one of the few centers in the New York area to perform it," said Leonard Y. Lee, M.D., program director of cardiac surgery at NYM.

The mitral valve sits within the heart, between two other valves: the atrium and the ventricle. From that position, it performs a very important function: it keeps blood flowing in one direction between the atrium and ventricle. When the valve is compromised by disease, one of two things happens. In the first scenario, the mitral valve gets leaky, allowing the blood to flow in the wrong direction. That usually results in a backup of fluid in the lungs and shortness of breath, leading to congestive heart failure. In the other scenario, the mitral valve becomes very narrow and does not allow blood to travel through the heart, also resulting in congestive heart failure. If this is left untreated, fluid can back up into the lungs, preventing the absorption of oxygen. Shortness of breath ensues and the heart, which is overworked, may fail to pump blood.

There are several causes for mitral valve disease. Childhood rheumatic fever may result in damage to the mitral valve later in life. Another cause is chronic high blood pressure. Mitral valve disease is typically detected during a routine diagnostic evaluation using an echocardiogram.

During the minimally invasive procedure to repair the damage, the patient is placed on a heart-lung machine, which takes over the pumping of the heart and the oxygenating of the blood. This procedure does not require stopping the heart, as is the case in traditional heart surgery. While the heart continues to beat, the function of pumping blood is temporarily outsourced to a machine, thereby clearing the heart of blood and allowing the surgeon a clear area in which to work. "Performing this procedure on a beating heart results in less trauma," said Dr. Lee. As long as it beats, the heart continues to receive nutrients, like oxygen, which are carried in the blood.

The minimally invasive procedure results in a reduced recovery time and the shortness of breath that is symptomatic of the disease is resolved. "We think that this procedure is revolutionary for heart surgery and it is a great benefit for patients who require mitral valve surgery," said Dr. Lee.