To a layman, the procedure appears impossibly clumsy – like performing surgery with long metal chopsticks. However, Dr. Michel Pellerin says the instruments, which include a tiny camera capable of great magnification and specially modified surgical tools, provide huge benefits for the trained surgeon.
"You see really well the [faulty] valve," Pellerin says. "It's really highly magnified, so you can see precisely what are the problems."
The main benefits, however, are for the patient. Where open heart surgery requires a long incision down the centre of the chest, the procedure employed by Pellerin and his partner, Dr. Denis Bouchard, involves a small incision in the right side of the chest. There is little obvious scarring, little pain during recovery and recovery is much faster, which means shorter hospital stays.
Eight years after sending a team member to Belgium to learn the technique for mitral valve repairs, Pellerin and Bouchard are now using the minimally invasive approach to perform a whole range of valve repairs and replacements as well as other operations to repair heart defects.
"It's truly the first approach here at the Heart Institute," said Bouchard, the director of cardiac surgery at University of Montreal. "We can now aim at close to 150 to 250 minimally invasive surgeries a year."
A less invasive procedure also means surgery becomes an option for elderly patients with heart disease who might not be able to survive a more traditional approach.
In November, Bouchard performed minimally invasive surgery on an 89-year-old woman. A month later, the elderly patient walked briskly into his outpatient clinic as if she had never had surgery.
"That's one month after surgery," said Bouchard. "That's something we have never seen before...Severely ill patients at an advanced age that can go through the surgery as if they were going through a hernia repair. It's really amazing."
Quick, painless recovery
More typical is Emile Sadaka's experience.
The 54-year-old contractor is a cycling enthusiast, but five years ago, a congenital heart defect that left him with a murmur started slowing him down.
"The more I trained, the worse it got," Sadaka said. "It got to a place where I actually couldn't train anymore."
Traditional open heart surgery to repair his defective mitral valve would have meant months off the bike – and off work, something the entrepreneur did not want and simply couldn't afford.
Sadaka's surgeon, fellow cycling enthusiast Michel Pellerin, suggested the minimally invasive approach.
"I was basically back on my bike in a month," Sadaka recalls. "I was back training within six months."
Two years later, he climbed Mont Ventoux – one of the toughest challenges on the Tour de France cycling circuit.
Clinical studies underway
Pellerin and Bouchard are convinced minimally invasive surgery will one day be recognized as the gold standard. However, they still need to prove that to their fellow surgeons, and a number of clinical studies are now underway.
"I see the patients in my office, and there is no doubt that they improve much, much faster," says Bouchard. "But does it mean they go back to work two months earlier, one month earlier, two weeks earlier? Does it mean they have a major decrease in post-operative pain, or a slight decrease?"
"These are things that we must publish properly to convince [other surgical] centres and to convince healthy policy makers that [this approach] is worthwhile."
Scores of visitors from all over the world have visited the Montreal Heart Institute and watched the procedure. Later this year, the institute will launch a new international master's program, in collaboration with centres in Belgium and Italy, to train more surgeons in the technique.