In some patients, a second or even a third heart surgery may be required after the first operation. These procedures, defined as re-operations, are always more challenging and riskier than the initial heart surgery. After the first surgery, adhesions usually form around the heart and the main vessel, the aorta. These adhesions are what make re-operations so complex. In order to proceed with surgery, these adhesions must be completely removed so that the heart and aorta can be exposed.
The greatest concern during this process is the risk of injuring the heart or aorta while separating the adhesions, which may lead to uncontrollable bleeding. In such cases, the patient may either lose their life on the operating table or face multiple organ failure after a prolonged stay in intensive care. For this reason, both surgeons and patients approach re-operations with extreme caution, taking every possible precaution against potential complications.
With endoscopic heart surgery, however, many of these risks can be avoided, making re-operations much safer. Let us briefly explain in which patients re-operations can be performed using the endoscopic method.
In some cases, coronary artery disease and mitral valve regurgitation occur together. If the mitral regurgitation is not severe, surgeons usually perform only the coronary bypass operation during the first surgery and leave the mild mitral regurgitation untreated. Over time, however, the regurgitation can worsen, leading to severe mitral valve insufficiency, which in turn causes heart failure. If not corrected, this condition may be fatal or require frequent hospital visits for treatment.
The greatest risk in such second operations is that the coronary bypass grafts from the first surgery are still functioning. During re-operation, these grafts can be damaged, causing sudden arrhythmias—a life-threatening complication that requires immediate intervention. However, urgency in re-operations also increases the surgical risk.
This is where endoscopic heart surgery offers a significant advantage. Without reopening the breastbone or disturbing the adhesions around the heart and aorta, surgeons can re-operate safely. By placing a high-definition 3D camera into the chest cavity, we directly access only the chamber of the heart that needs intervention, allowing us to repair or, if necessary, replace the mitral valve with minimal trauma.
Another common group of patients are those who have previously undergone mitral valve surgery but whose tricuspid valve—located on the right side of the heart—was either left untreated or only partially repaired during the first operation. Over time, these patients often develop worsening tricuspid valve regurgitation, leading to signs of right heart failure. Symptoms include abdominal swelling, fluid buildup in the abdomen (ascites), leg edema, and marked distension of the neck veins.
Initially, regular use of diuretics may provide some relief, but their effect gradually diminishes as the condition worsens. Once right ventricular failure develops, surgery may no longer offer meaningful benefit. For this reason, early surgical intervention is crucial and life-saving. However, since this is a re-operation, patients often hesitate to proceed, and as time passes, the potential benefits of surgery decrease.
With endoscopic heart surgery, re-operations for tricuspid valve disease have become much easier. Using a small incision, a high-definition 3D camera is inserted into the right chest cavity, directly accessing the chamber where the tricuspid valve is located. The valve can then be repaired or replaced on a beating heart, without the need to stop the heart completely.
Another group of patients includes those who have previously undergone aortic valve surgery but later develop problems with the mitral valve. In such cases, endoscopic heart surgery also allows for safe and effective re-operations on the mitral valve without reopening the breastbone or disturbing adhesions.
In summary, a significant number of repeat heart surgeries can be safely performed through endoscopic techniques, avoiding the major risks traditionally associated with re-operations and allowing patients to undergo even second or third procedures with reduced complications.
After the first heart surgery, adhesions often develop around the heart and the main vessel, the aorta. These adhesions are the main factor that make re-operations more difficult and risky compared to the initial surgery.