Minimally Invasive Mitral Valve Surgery

Stanford Health Care offers superior options in cardiac surgery, including the latest techniques and research for minimally invasive cardiac surgery. Advanced research and operative techniques give patients a repair of their native valve with the use of their own natural heart tissue.

Minimally Invasive Mitral Valve Surgery

Normal Mitral Valve Anatomy

During this procedure, adequate visualization is key to ensuring a safe and effective operation. The small, right-sided incision made in this minimally invasive procedure provides a direct view of the mitral valve that is equivalent to that obtained via a sternotomy. The surgeon can access the entire surgical field to safely and effectively perform a valve repair or replacement. This view also allows for advanced repair techniques, including complex leaflet work and the implantation of an annuloplasty ring.

The mitral valve is located on the left side of the heart between the left atrium and the left ventricle. With each heartbeat, the mitral valve opens and allows blood to flow from the left atrium into the left ventricle. In mitral valve prolapse, the two leaflets do not close properly, causing regurgitation, or the backflow of blood, into the left atrium. Regurgitation forces the heart to work harder to eject blood out of the heart and to the body and can permanently damage the heart. Over time, this excess work may cause the heart to enlarge, which predisposes patients to abnormal heart rhythms and heart failure. Surgical intervention is necessary to prevent harmful changes to the heart and to stop the progression of these symptoms.

Current guidelines recommend early surgical repair, even in asymptomatic patients, at a nationally recognized cardiothoracic surgical center of excellence. Stanford Health Care was awarded the Mitral Valve Repair Reference Center Award by the Mitral Foundation and the American Heart Association for our expertise in mitral valve repairs.

For decades, the standard surgical approach to mitral valve repair has been a median sternotomy, where an incision is made down the length of the sternum. Increasingly, patients are seeking a less invasive approach to this standard procedure. Using a smaller incision, minimally invasive mitral valve repair has proven to be an effective and highly durable alternative, reducing the need for subsequent surgeries and improving patient safety.

Candidates for Minimally Invasive Mitral Valve Surgery

A broad range of patients are eligible for minimally invasive approach via the right chest, including those with:

  • Mitral valve prolapse and/or regurgitation
  • Mitral stenosis requiring a mitral valve replacement
  • Atrial fibrillation requiring a Maze procedure and left atrial appendage exclusion
  • An atrial septal defect (ASD) or patent foramen ovale (PFO)
  • Tricuspid valve disease

It is important to note that not all patients are good candidates for a minimally invasive approach. Eligibility factors for performing a safe procedure via the right chest include comorbidities, prior surgeries, height, weight, and physique.

Benefits of Minimally Invasive Mitral Valve Surgery

  • Avoids a sternotomy incision and eliminates risk of sternal wound complications
  • Reduced risk of infections
  • Small, right-sided chest incision measuring 4-5cm
  • Minimal scarring that can be easily concealed under clothing for eligible patients
  • Safe and effective repair that will be durable in the long term
  • Concomitant procedures are possible
  • Lower risk of complications
  • Reduced risk of post-operative bleeding and blood transfusions
  • Comparable outcomes when compared to similar surgery completed via a sternotomy
  • Shorter ICU stay
  • Shorter hospital stay, typically five days
  • Faster return to an active life, typically four weeks

Minimally Invasive Surgery Setup: Small, 4cm, mini right thoracotomy approach, port access, instruments & 2cm groin cannulation

Procedure Details

  • Standard arterial line and central venous line for monitoring and medication administration
  • Single-lung ventilation with a double lumen endotracheal tube
  • Access to the mitral valve via a small 4-5cm right-sided chest incision between the 3rd and 4th ribs
  • A small, 2-3cm incision in the groin for femoral arterial and venous cannulation, both of which are removed upon completion of the operation
  • Three small lateral incisions for minimally invasive surgical instruments
  • Intra-operative TEE to confirm adequate valve repair
  • Standard chest tube placement to prevent accumulation of excess blood and fluid within the chest after surgery
  • All incisions are closed with dissolvable sutures

Minimally Invasive Incision: Small 4cm mini right thoracotomy incision instead of the larger median sternotomy

Transfer Center and Referral Information

Patients and Families (Self-Referral)

The patient’s doctor will request an evaluation by the Stanford Advanced Lung Support team, who will review their previous medical records and determine if additional tests are necessary. After reviewing the patient’s information, the team will provide further details regarding patient transfer.   You can call the clinic number below to speak with one of our clinic staff about the status of your referral or self-referral.  They will help guide you through the process or next steps needed.  

We use a multi-disciplinary approach to diagnose and treat patients with valvular heart disease, offering repair and replacement for heart valves.

Stanford Referral Center and Clinics are staffed Monday through Friday from 8 am - 5 pm (PST)

We have several locations where our surgeons can see you for a consult, offering you convenience closest to your home.    

Our main Adult Heart Surgery Clinic & Surgery schedulers number to call for an appointment is: 650-724-7500

Our direct clinic contact information and locations are:

Heart Surgery in Palo Alto
Heart and Vascular Center
300 Pasteur Drive
3rd Floor, Clinic A31
Stanford, CA 94305
Phone: 650-724-7500
Map of Stanford Hospital

Aortic Disease Center
Heart and Vascular Center
300 Pasteur Drive
3rd Floor, Clinic A31
Stanford, CA 94305
Map of Stanford Hospital

Heart Surgery in Pleasanton 
5565 W. Las Positas Blvd.
Suite 320
Pleasanton, CA 94588
Phone: 925-278-7017

Heart Surgery in San Jose
751 S. Bascom Avenue
San Jose, CA 95128
Phone: 408-885-3838

Interested in an Online Second Opinion?

The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. It’s all done remotely and you don’t have to visit our hospital or one of our clinics for this service. You don’t even need to leave home! Visit our online second opinion page to learn more.

International Patient Referrals

Phone: +1 650-723-8561

International Medical Services (IMS) at Stanford Health Care provides information, interpretation and translation services, and other supportive services for patients and families who may be seeking care from out of country.  

For Physicians / Health Care Professionals

Transfer Center
Phone: 1-800-800-1551  (24 hours - 7 days a week)
Fax: 650-723-6505

Physician Helpline
Phone: 1-866-742-4811 
Fax: 650-320-9443
Monday – Friday  8:30 a.m. – 5 p.m. (PST)
After hours: Call the hospital page operator at 650-723-4000 and ask for the physician on call

FAX: Fax a referral to the Cardiothoracic Surgery Department at 650-736-0901  

Online Portal (PRISM)

Our online portal, known as PRISM (Physician Referral Information at Stanford Medicine), provides a streamlined platform for community physicians to send referrals, check on referral status, access medical records, and message Stanford providers.

If you have any questions about the referral process, please call us at 650-724-7500.