At Harefield Hospital, patients suffering from multiple life-threatening heart problems can have up to four surgical procedures completed during a single operation, using minimal access techniques.

In this procedure, instead of accessing the heart via sternotomy (a large incision through the breastbone), the heart is accessed via a handful of small cuts.
The operation is video-assisted, utilising a state-of-the-art 3D camera and a large high-definition monitor which gives an extremely clear view inside the body, instead of using direct vision which requires a larger access port.

Mr Toufan Bahrami, consultant cardiac surgeon, who has pioneered the technique at Harefield Hospital, explains how the aortic valve is accessed:

“It’s done endoscopically with three small access holes. One for the camera, one to put a clamp on the aorta, and one to expose the valve.”

The instruments used in video-assisted surgical procedures are different to those used in traditional surgery, and it takes many years of training to develop the skills needed.

Depending on the condition of the patient, the surgery is either conducted ‘off-pump’ while the heart is still beating, or a heart-bypass machine is used to stop the heart for as little as 10 minutes (compared to 30 minutes in traditional surgery).

The patient can have up to four procedures in the same theatre slot: fixing the mitral valve, tricuspid valve, ablation, and left atrial appendage closure.

This is very beneficial for the thousands of patients each year who develop a number of heart problems, as it saves them from undergoing two or more separate operations. It helps to reduce the disruption to their daily life, allowing them to get back to hobbies and work more quickly, rather than undergoing another heart operation within a short space of time.

A centre of excellence

A handful of other hospitals in the UK offer mitral valve surgery using keyhole techniques, but there are very few who can treat multiple problems in one operation – all endoscopically like at Harefield.

Mr Bahrami adds: “I don’t recall anyone else doing mitral, tricuspid and ablation in the same set. Usually they treat the mitral valve and then leave the other parts without treating them.”

While other hospitals may only conduct one or two mini-access heart surgeries a month, what makes Harefield outstanding and unique is the number of times these procedures are performed: “Every week, we do at least two of these types of surgery.”

Innovation of Harefield

This revolutionary technique is available to patients thanks to the years of innovation and expertise from researchers and clinicians at Harefield Hospital, including Mr Bahrami.

“We have done mini-access heart surgery here since 2001. We started with bypass, then endoscopic vein harvesting, then mini sternotomy aortic, then mini thoracotomy aortic, then we went to mitral. The programme that we are doing today has at least fifteen years’ experience behind it,” Mr Bahrami says.

The whole theatre team – including anaesthetists, nursing staff, and perfusionists – have been trained and are experts in the technique.

“It’s not just one person – there is a whole team who are ready to do it. They have the skills and are used to it. Everyone is comfortable, and we have a plan for the operation. We have done many surgeries of this type.”

Better recovery

The operation takes about three hours and the patient typically stays at the hospital to recover for around five to seven days.

Comparing the mini-access procedure to the more standard sternotomy approach, Mr Bahrami says: “The length of stay in the hospital is mainly the same; what makes a difference is afterwards. The integrity of the chest is preserved, so therefore the recovery is much quicker.”

“Those who have a sternotomy can suffer for around two to three months. They often can’t go back to work. They can’t drive for eight weeks at least. They can be very slow in recovery,” Mr Bahrami says.

For obese patients, with traditional surgery they could spend “months” in the hospital. But with minimally invasive surgery, Mr Bahrami says: “They can go home after a much shorter period of time as their recovery is so much better – in as little as three days.”

At a glance


4-in-1 heart surgery using minimal access.

Carried out by

Mr Toufan Bahrami

What problem does it solve?

Patients’ symptoms and quality of life is improved by fixing up to four issues in one go: the mitral valve, tricuspid valve, ablation, and left atrial appendage closure.

How does it work?

The surgeon uses cameras to guide the instruments during the operation. Using the same access ports, or additional keyholes depending on requirements, multiple heart surgeries can be performed during the same operation.

The heart is accessed through a few small cuts, which is less invasive than conventional sternotomy, and is associated with improved recovery. Patients benefit from smaller, neater scars. Post-operative pain is reduced, and the recovery process is quicker.