Human heart
Two patients received successful aortic valve replacements without opening the chestWikimedia Commons

Surgeons in France have completed the first successful heart surgery on a human without opening the chest.

Two patients underwent a totally endoscopic aortic valve replacements (TEAVR), which shows the potential for improving the quality of life of heart patients by offering significantly reduced chest trauma.

Endoscopic surgery is already used by cardiovascular surgeons for procedures such as atrial septal defect repair and coronary artery bypass grafting. This leads to faster recovery time and less pain.

Marco Vola, of the Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Saint-Etienne, said: "It is important to note that when performing TEAVR, a quick and safe conversion to mini-thoracotomy under direct view can be made if circumstances demand. This would still offer significantly reduced chest trauma."

Human heart surgery without opening chest
The skin of the patient three months after TEAVR surgeryAmerican Association for Thoracic Surgery

He added: "In our institution, we began by adopting the mini-sternotomy technique, involving a small incision through the sternum, as routine.

"We then transitioned to the right mini-thoracotomy approach, involving a small incision through the thorax, first under direct view, then with an endoscopic camera. Finally we adopted a totally endoscopic technique."

The surgery was reported in the Journal of Thoracic and Cardiovascular Surgery.

TEAVR had not previously been feasible because of the current available designs of stented tissue valves. The recent advent of sutureless bioprostheses mounted on a compressible self-expanding nitinol (nick titanium) stent, was one of the key factors which allowed the surgical team to perform the procedure.

Implantation of the stent required less than 45 minutes in either patient, while sutureless substitutes are not yet available for other cardiac valves, such as the mitral valve.

In other fields, totally endoscopic surgery involved longer clamping and cardiopulmonary bypass (CPB) times during the learning curve. Researchers believe that clamping and CPB times were acceptable and that the learning curve could be shorter than reported for totally endoscopic coronary artery bypass grafting.

According to Dr Vola and his team, enhancements such as endoscopic sizers, dedicated instruments for decalcification and second-generation sutureless bioprostheses to simplify implantation, could improve the procedure further.

He also suggested that surgical robots may offer additional benefits.

Dr Vola added: "These first procedures show that totally endoscopic sutureless aortic valve replacement is technically feasible. Further clinical experience and technical development are necessary to shorten operation times and to assess further the potential postoperative benefits of TEAVR."