York County Medicine Summer 2019 - 10

YO R K C O M E D S O C . O R G

FEATURE:

iSVR - Intercostal Surgical
Valve Repair/Replacement
Minimally invasive procedure yields
maximum results for patients
by Mubashir Mumtaz, MD, FACS, FACC
Chief of Cardiothoracic Surgery, UPMC Pinnacle

H

eart valve disease is nothing new and remains a significant
concern for patients and physicians alike. In fact, more
than five million Americans are diagnosed with heart
valve disorder each year. The good news, however, is the mortality
rate for people suffering valvular heart disease is declining. This
is in part attributable to the progress made in early diagnosis and
innovative treatments over the past decade. Today, there are many
more options for men and women living with valvular heart disease.
Although it remains a major problem, we are finding resolutions
with minor or minimally
invasive procedures.
Since the advent of
TAVR
(Transcatheter
Aortic
Valve
Replacement), interest
in less invasive surgical
techniques has also
increased. TAVR is
performed via access
through the groin without the need to make an incision on the
chest. Having performed several hundred TAVRs, I saw the quick
recovery and improved quality of life among patients. While some
patients might be candidates for such revolutionary valve treatment
as TAVR, others are not.
After witnessing patients healing slowly and with significant
discomfort from traditional surgical options, I searched for an
alternative to the already minimally invasive techniques being used
for sternotomy. I began to question how we could avoid cutting
into bone, cartilage, and major muscle groups during surgery.
The answer came in the form of Intercostal Surgical Valve Repair/
Replacement (iSVR), which I developed in 2014. The process
involved contributions from many other physicians before me and
others who had similar techniques but different in many ways. I
learned from all of them and improved and modified the procedure

10

York County Medicine | SUMMER 2019

to maximize its benefit to the patients. This procedure allows access
to the chest cavity by making an incision approximately one-inch
laterally on the right side of the chest rather than the large vertical
incision down the middle typically used in traditional sternotomy.
With iSVR, surgeons enter the rib space via the intercostal
space, thereby preserving the right mammary artery and avoiding
additional trauma such as cracking the sternum or cutting a rib
or the cartilage. What began initially for mitral valve repair and
replacement (iSMVR: intercostal mitral valve repair/replacement)
has since been expanded
for use with aortic
(iSAVR:
intercostal
surgical aortic valve
replacement), tricuspid,
simultaneous
double
valve and triple valve
surgeries.
We
have
found great success at
UPMC Pinnacle with
this approach which means that our patients have shown better
outcomes and an improved quality of life. To date, I have performed
more than 750 iSVR surgeries with excellent outcomes.
UPMC Pinnacle performs more valve surgeries than any
other hospital in the state with combined "significantly lower
than expected" mortality and readmissions for heart valve surgery,
according to the Pennsylvania Health Care Cost Containment
Council (PHC4) Cardiac Surgery in Pennsylvania Report published
in January 2017. Aortic valve disease may be a condition present at
birth, or it may result from calcium buildup from aging of the valve.
The disease may cause narrowing of the valve limiting blood flow
(stenosis), or a leaky valve preventing proper closure and function
(regurgitation).


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York County Medicine Summer 2019

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