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First is conventional cardiac surgery that would be the operation done through a median sternotomy that is splitting the breastbone approach. This approach to the heart is a tried and true technique. Most surgeons feel very comfortable using this approach and will be able to handle almost any type of cardiac surgical problem. There are years of experience and data concerning the expected outcomes for all major surgical procedures using the conventional median sternotomy approach. Since most surgeons feel very comfortable with this approach, it is their preferred technique for all cardiac surgery.

The second approach that you will see is a more minimally invasive approach. In my practice it is exceedingly rare to perform an isolated aortic valve through a conventional median sternotomy. We started off the minimally invasive cardiac surgical program doing aortic valves through a smaller 5 – 6 cm upper sternal splitting incision and then transitioned to an incision off to the right side measuring anywhere from 4 – 7 cm depending on the patient’s body size. All of our first time and most of our redo aortic valves that do not need coronary work are done through this minimally invasive incision. You will see some very clear views of the aortic valve, which were not possible prior to making this transition. During the transition we, as a surgical team, learned to operate off of a video screen using high definition cameras and special instruments, which were designed for this approach. These instruments have also opened up the ability to do conventional surgery without spreading the sternum quite as much. They have also allowed us to work at odd angles very far away. You will see a video or two showing that these instruments can be used in conventional surgery and showing how the addition of these techniques to our surgical armamentarium has tremendously benefited our patients.

Thirdly, you will see robotic approaches to intracardiac work. There are several videos, which will continue to grow in this library, of robotic approaches to the mitral valve. With this approach, a high definition three-dimensional camera shows incredible views of intra cardiac anatomy.  Only the operative surgeon could see these images in the past. It has allowed us to become very facile with the delicate intracardiac structures which control the mitral valve and from a personal perspective it has given me much more insight into the physiology of the valve as well as the importance of the valvular mechanisms working in concert.

As the website continues to build we will try to add some non-cardiac surgical procedures and add videos showing some more techniques, particularly in bypass surgery which we are presently working on to make the approach less and less invasive.

Finally I need to thank sincerely the staff at St. Joseph Hospital, particularly in the operating room and our anesthesiologists who have stuck with it as I have serially introduced more and more complex non-conventional techniques. They have had to go through a, sometimes rather frustrating, learning curve; our operations take much longer because of the smaller incisions, but they understood that the long term project was not about how long they had to work, but about the ultimate improved outcome and more rapid recovery of our patients.

Every time we have mastered some technique we have continued to move the bar and apply that technique to more and more complex and more and more frail patients. Personally, I believe this is where these techniques will have their most benefit, allowing us to care for people while minimizing trauma to the body and mind. 

I hope you enjoy the videos.

Michael E. Sekela, M.D.