Minimally Invasive and Endovascular Aortic Procedures

What are minimally invasive and endovascular aortic procedures?

Minimally invasive aortic procedures involve making small incisions in the skin to perform a surgical procedure. It is sometimes possible to repair valves, such as the aortic or mitral valves, through 2 to 3-inch incisions between the ribs or through the breastbone, avoiding the need to open the chest completely. 

These kinds of minimally invasive procedures can result in reduced scarring, less postoperative pain, and a shorter recovery time when compared to open heart surgery, which has traditionally been the only method for repairing or replacing valves.

Another form of minimally invasive surgery is known as the endovascular approach, which involves making a small incision near the hip and threading a stent graft through the blood vessels leading to the aorta.  Currently, this kind of procedure is used for abdominal and descending thoracic aneurysms. Endovascular repairs can result in minimum or no scarring, minimum or no postoperative pain, a short hospital stay, and shorter recovery time than traditional approaches.

Who needs minimally invasive or endovascular aortic procedures?

Minimally invasive valve repairs are good options for those concerned with the cosmetic result of heart surgery, but they can be more technically challenging than traditional open heart surgeries and require a surgeon with experience in minimally invasive approaches. 

Endovascular repair has become a mainstream option for descending thoracic aneurysms, producing similar results to open approaches. Ongoing studies are looking in to the use of endovascular repair for aneurysms of the ascending aorta and aortic arch.  

For everyone with aortic disease, minimally invasive and endovascular options will be considered. In some cases, a hybrid approach that combines endovascular and open heart techniques may be used to complete a repair in a single trip to the operating room. 

What happens after minimally invasive or endovascular aortic procedures?

Like any surgical procedure, recovery depends on numerous factors. One of the advantages of minimally invasive and endovascular procedures is that they are associated with reduced scarring, less postoperative pain, and shorter recovery times than open approaches. After surgery, follow-up with a cardiologist, as well as imaging studies, will be requested to evaluate the surgical results, as well as create an effective postoperative treatment plan. 

For all those with aortic disease, surgery is often merely part of longer-term management, which will include clinic visits as well as imaging.

What are the alternatives to minimally invasive or endovascular aortic procedures?

The main alternative to minimally invasive or endovascular aortic procedures is the traditional, open heart approach to valve replacement and aneurysm repair. 

What are the risks associated with minimally invasive or endovascular aortic procedures?

Minimally invasive valve repair or replacement is a relatively low-risk surgery, with complications estimated at 1-3%.

Minimally invasive aortic aneurysm repair, because of the severity of the condition and complexity of the procedure, is offered only by specialized centers. 

Risks involved in minimally invasive and endovascular approaches to aortic surgery include:

  • Infection
  • Bleeding
  • Kidney injury
  • Stroke
  • Blood clots, especially in the case of mechanical valves