iSVR: Intercostal Surgical Valve Replacement

Intercostal surgical valve replacement (iSVR) is a minimally invasive procedure for treating conditions of the aortic, mitral, and tricuspid valves. It refers to the technique of accessing valves through the ribs without cutting the breastbone.

Our cardiovascular specialists are some of the most experienced in the region and began performing the iSVR procedure in 2014 to treat aortic valve disorders. Since then, our skilled surgeons have completed hundreds of iSVR procedures with excellent outcomes.

What Is iSVR?

iSVR is a minimally invasive procedure that treats conditions of the aortic, mitral, and tricuspid valves. Using the iSVR approach, your surgeon can access your valves through the intercostal space between your ribs using a one-and-a-half-inch incision in your chest — without opening your chest or cutting your breastbone.

Types of iSVR

Our surgeons use the iSVR technique for several procedures, including:

• Aortic valve replacement.
• Mitral valve repair/replacement.
• Double valve repair/replacement.
• Mitral and tricuspid valves.
• Mitral and aortic valves.
• Some coronary artery bypass graft (CABG) surgeries.

Conditions we treat with iSVR

• Aortic valve stenosis.
• Aortic valve regurgitation.
• Aortic valve prolapse.
• Coronary artery disease.
• Mitral valve prolapse (MVP).
• Mitral valve regurgitation (MR).
• Mitral valve stenosis.
• Pulmonary valve stenosis.
• Pulmonary valve regurgitation.
• Pulmonary valve prolapse.
• Tricuspid valve stenosis.
• Tricuspid valve regurgitation.
• Tricuspid valve prolapse.

Why Would I Need iSVR?

If you have been diagnosed with a valve disorder, iSVR could be a treatment option for you.

Who’s a candidate for iSVR?

You may be a candidate for iSVR if you have a valve disorder and are unable to have a traditional surgical or catheter-based procedure to repair or replace your valve.

Alternatives to iSVR

• Open heart surgery which involves opening the chest bone.
• Catheter-based minimally invasive surgery using catheters inserted in the groin or wrist area.

What Are the Risks and Complications of iSVR?

As with any cardiac surgery, iSVR poses risks and complications like:

• Blood clots.
• Internal bleeding during or after surgery.
• Arrhythmia (abnormal heart rhythm).
• Infection.

Some people may have a slight fever or get pneumonia after surgery.

Your age, other health problems, and the severity of your valve disorder also increase the likelihood of complications after surgery.

If you have any concerns, talk to your doctor before having iSVR.

What Should I Expect From iSVR?

Traditional open-chest valve replacement procedures usually require large incisions and/or the division of major muscle groups, ribs, and cartilage. In addition to causing less trauma to the body, iSVR offers several benefits, including:

• Excellent cosmetic results.
• Quicker recovery.
• Less time in the intensive care unit (ICU) and hospital.
• Lower chance of blood transfusion.

Before: How to prepare for iSVR

Your doctor will explain the iSVR procedure to you and give you a chance to ask questions. To prepare for iSVR, you should:

• Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
• Fast for a certain period of time prior to the procedure. Your doctor will tell you how long to fast (usually overnight).
• Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.

On the day of your iSVR procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home.

You will stay in the hospital for a few days after your procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home after you are discharged from the hospital.

How long does iSVR take?

The iSVR procedure typically takes several hours, depending on your condition.

During your iSVR

You will be positioned on a table and placed under general anesthesia. You will be connected to a heart-lung bypass machine that will take over the function of your heart and lungs during your operation.

Your doctor will make a one-and-a-half-inch incision in your chest and access your heart through the intercostal space between your ribs. Your doctor will then perform your valve repair or replacement.

Recovery after iSVR

When your heart valve procedure is completed, you will be moved to recovery for observation and monitoring. Your doctor will provide more information about your recovery and your hospital stay.

Your doctor will also let you know when you can resume your normal activities. When compared to traditional open-chest surgery, patients who have an iSVR procedure typically experience less pain, have a shorter hospital stay, and recover more quickly. However, you should follow your doctor's instructions and go to all of your follow-up appointments.

When to call your doctor about iSVR complications

You will be closely monitored while you are in the hospital after your iSVR procedure. After you go home, you should let your doctor know if you experience:

• Signs of infection, such as fever or cough.
• Redness, swelling, or drainage from your incision site.
• Symptoms of cardiac problems, such as chest pain or abnormal heart rhythms.
• Difficulty breathing.
• A fever of more than 100.0°F.
• Any other symptoms that worry you.

What’s the prognosis after iSVR?

iSVR is an effective valve disease treatment option that can reduce your symptoms and improve your quality of life. However, your specific prognosis will depend on a number of factors that your doctor will discuss with you.

What’s the success rate of iSVR?

When performed by experienced cardiac surgeons such as the team at UPMC, iSVR procedures are successful at restoring normal valve function. Your doctor will discuss the expected success rate of your procedure.

Why Choose UPMC for iSVR?

Our cardiovascular specialists have performed hundreds of iSVR procedures since 2014 with outstanding outcomes, placing them among the most experienced iSVR surgeons in the region.

By UPMC Editorial Staff. Last reviewed on 2024-10-01.