Conventional surgery via sternotomy

The Sternotomy is the standard approach in cardiac surgery with a large cut in the middle of breast bone. 99% of surgeons in the UK are using this approach for mitral valve repair. It requires a large incision and multiple dissections in the chest to reach the mitral valve with central cannulation for heart and lung bypass machine. Conventional surgery, through a midline sternotomy, generally has a longer recovery period (up to 3 months). Sometimes, sternotomy is the only possible option for surgery when less invasive alternatives are not appropriate.

Surgery remains the Gold Standard treatment for severe degenerative mitral valve regurgitation (leak).
A diseased or damaged mitral valve might eventually need to be repaired or replaced, even if you don't have symptoms (when there is severe mitral valve regurgitation).

Surgery for mitral valve disease includes mitral valve repair and mitral valve replacement.
Mitral valve repair provides a lower operative risk, better short- and long-term outcome with better valve function when compared to replacement.

In cases where the valve is not repairable (e.g. in cases of rheumatic disease, infection, calcification) your surgeon will discuss the risks and benefits of each type of heart valve with you to determine which valve may be best for you.
The mechanical mitral valve is a large valve which can sometimes be noisy. Durability is on average over 30 years and requires lifelong anticoagulation with warfarin.

The biological mitral valve has a shorter longevity (10-12 years in average) but it does not necessarily require lifelong anticoagulation. You may, of course, need anticoagulation for other reasons.
If you need surgery for another heart condition, a surgeon might perform mitral valve repair or replacement at the same time as that other surgery.

Surgical approaches for mitral valve surgery

Sternotomy: Mitral valve surgery is usually done in the UK through a large cut (20-25 cm) through the breastbone with longer recovery (up to 3 months).

Minimally Invasive direct vision (5 to 6 cm)- Mini-Thoracotomy

Totally Endoscopic (3 to 4 cm)- Incision using 3D camera system with robotic arm

Surgical Mitral valve repair techniques (sternotomy/ minimally invasive and endoscopic)

Correcting the leaflet’s excess tissue

Leaflet preservation
Leaflet resection (triangular/ quadrangular resection)
Leaflet plication

Correction of chordal elongation/ rupture

Artificial PTFE chordae implantation (neochords)
Papillary muscle repositioning

Correction of annular dilatation

Annuloplasty ring
Complete ring (ideal ring)
Incomplete ring

Mr Bahrami has performed more than 1500 Mitral valve surgeries in his career to date out of which more than 500 have been through a minimally invasive or totally endoscopic approach (Keyhole)

He’s currently the most experienced practising mitral valve surgeon in UK with expertise in minimally invasive and endoscopic 3D valve repair with repair rate over 99% and overall risk of 1%.

Our Team

Toufan Bahrami

Mr Toufan Bahrami is a senior consultant in cardiac surgery , working at both Royal Brompton and Harefield Hospital, where he treats both NHS and private patients.

He also works at The Harley street clinic in central London .With more than 4000 cardiac operations of which 1500 are minimally invasive procedures over past 21 years, He is the only consultant in UK expert in all aspects of minimally invasive cardiac surgery including , Mitral , Aortic valve and root and CABG with a longstanding track record.

Saeed Mirsadraee

Dr Mirsadraee’s specialist interest is cardiovascular imaging and in particular imaging of the heart valves, surgical and transcatheter aortic and mitral valve procedure planning, and complex aortic conditions. He is the radiology lead for aortic and mitral imaging at the Royal Brompton and Harefield hospitals. Dr Mirsadraee uses CT images in planning Mitral valve procedures such as minimal access mitral valve surgery, transcatheter mitral valve implantation (eg. Tendyne, Sapien in ring/MAC), cord and left ventricular remodelling procedures (eg. Accucinch, Neocord).

Ali Vazir

Dr Ali Vazir is a consultant cardiologist based at the Royal Brompton and Harefield Hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust. He is also an Honorary Clinical Senior Lecturer at National Heart and Lung Institute, Imperial College London.

He is an expert in heart failure and echocardiography. He is the clinical lead for heart failure at the Royal Brompton Hospital. He trained in London and was a Post-doctoral research fellow at the Brigham and Women’s Hospital and Harvard Medical School, Boston, USA. He is a principal investigator for several multicenter trials.

Lauren Connolly

Lauren has worked within the cardiology and cardiac surgery care setting for seven years. In recent years she has worked within the structural heart team as clinical nurse specialist and co-ordinator for the trans catheter team, specifically focusing in mitral and tricuspid valve disease.

Dr Robert Smith

Dr Smith’s specialist interest is Mitral valve disease and interventions. He leads one of the largest structural heart disease programmes in Europe at the world renowned Royal Brompton & Harefield Hospitals. It is also the first centre of excellence for MitraClip in the world.