Redoing heart valve replacements using a minimally invasive approach

There are some instances in life where you wish you could have a redo, but surgery isn't one of them. However, if a redo is necessary, knowing that there is a minimally invasive option can be comforting. Dr. Joseph Lamelas, professor and associate chief of cardiac surgery in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, discusses a minimally invasive approach to redoing valve replacements.

"If the first valve repair or replacement begins to leak or becomes scarred, causing the valve to narrow, a redo or reoperation will be required," said Lamelas, who conducts surgeries at Baylor St. Luke's Medical Center. "This is true for all heart valves."

Lamelas said that while valve replacement or repair redos are not common, they do consist of about 20 percent of his practice.

"All valves can be reoperated on and will most likely will need to be replaced as opposed to repaired, because after many years, the valves become scarred and damaged," Lamelas said. "The average length of time for when a replacement surgery is needed is about 10 to 15 years after the first surgery."

While many valve repairs and replacements are performed by opening the breast bone, Lamelas is able to do these procedures using a small incision on the right side of the chest, working between the ribs with specialized equipment and instruments to access the valves. Even if the patient previously had a sternotomy, their redo surgery can be performed using Lamelas' minimally invasive technique, which allows for a shorter stay in the hospital and a shorter recovery time. Lamelas also has applied his unique minimally invasive approach to patients requiring redo surgery for a second or third time.

Signs that a patient needs to redo a valve repair or replacement are similar to the initial symptoms they had before their first surgery, which include fatigue, shortness of breath and weakness.

"If one begins to have symptoms and their valve has deteriorated, the benefits of having surgery outweigh the risks," Lamelas said. "Over time, a deteriorated valve can lead to deterioration in heart function."