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MHI performs endoscopic cardiac surgery

MONTREAL – In May, a multidisciplinary team at the Montreal Heart Institute (MHI) performed endoscopic mitral valve surgery for the first time. Two other cases were successfully treated in the days that followed.

These surgical procedures, involving repair of the mitral valve, are a first for the MHI and represent an important leap forward in the development of mini-invasive surgery. The program at the MHI is funded by the Hornstein Chair, which was created by the MHI and the Université de Montréal in 2004.

The team performing this first procedure was composed of Drs. Denis Bouchard, cardiac surgeon, Michel Pellerin, cardiac surgeon and holder of the Hornstein Chair, and Pierre Couture, anesthesist, as well as three nurses, two perfusionists and an inhalation therapist. The team members were trained by Dr. Hugo Vannerman, a Belgian surgeon who has amassed a wealth of experience in Aalst, Belgium, one of the few centres in the world to perform this type of surgery.

Two incisions were made, one 5 cm long under the right breast, between two ribs, the other 3 cm long in the groin, used to insert the cameras and provide magnification of the mitral valve. The surgeons then proceeded to repair the mitral valve.

This type of procedure results in many benefits for the patient: less pain, since the rib cage remains intact, unlike in cases of open-heart surgery; quicker recovery, that is, a one-month convalescence as opposed to three months for the traditional surgery; and a remarkable outcome in aesthetic terms because of the smaller incisions required for endoscopic surgery.

There is no standard profile of patients with cardiac mitral valve pathology; it affects men and women of all ages, regardless of their lifestyle. The pathology is due to degeneration of the supporting tissues, with the valve gradually becoming “insufficient” and causing increasingly pronounced shortness of breath. The first patient, a 37-year-old resident of Alma, was diagnosed with this pathology eight months ago and was forced to stop working. Thanks to endoscopic mitral valve surgery, the medical-surgical team at the MHI was able to significantly improve the quality of life for the patient.

“Before the surgery, I was constantly out of breath, and because I worked as a carpenter in the construction sector, I had to stop working and cut my activities down to a minimum, which is not easy for a person my age who is used to being very active,” confided Mr. Stéphane Bouchard, the first person to benefit from this surgery at the MHI. “Since my operation, I’ve been able to recover quickly, and the difference in my health is tremendous. I appreciate every breath I take, and I’m very happy to reap the benefits of this new approach and, of course, avoid open-heart surgery.”

“The MHI has developed a high level of expertise in cardiac valve reconstruction surgery, and the success of these first three procedures represents an important breakthrough in the development of mini-invasive cardiac surgery,” says Dr. Denis Bouchard. “At the MHI alone, over 700 patients have undergone valve surgery in 2005-2006, which is about 40 percent of all cardiac surgery cases. This new technique, performed using cameras and endoscopic instruments, could be applied to the majority of cases of mitral valve repair surgeries performed annually at the MHI; some 281 mitral valve repair surgeries were performed in 2005-2006. In the medium term, this approach could also be extended to the treatment of coronary diseases and aortic valve pathologies, notably by way of robotic cardiac surgery.”