Two patients have become the first in Israel to have defective heart valves successfully replaced by artificial implants using a catheter threaded from a vein into the heart - thus avoiding open-heart surgery and long hospitalization and recovery. The minimally invasive heart valve surgery, first introduced abroad a few years ago and today available only in a few medical centers around the world, was performed Wednesday at Jerusalem's Shaare Zedek Medical Center by staffers of its catheterization unit, The Jerusalem Post has learned. The team included surgeons from Greece and France who trained Shaare Zedek doctors in the procedure. The first patient is a woman, and the second is a male tourist from the US who informed the Post about it half an hour before he was to undergo the operation. Minimally invasive heart valve surgery requires much smaller incisions than those typically used in an open-heart surgery to repair or replace a defective heart valve. The patient thus avoids the opening of the chest and the sawing and retraction of the breastbone to reach the heart. The actual valve replacement is the same in both types of surgery, but the minimal procedure generally takes longer because of its greater complexity. In the surgical technique used at Shaare Zedek, called percutaneous heart-valve implantation and using transcatheter valves, the surgeon makes small incisions in the chest to attach a heart-lung machine, as the heartbeat is stopped, followed by drainage of the blood in the heart. Then the heart valve is replaced using a balloon catheter and a supportive stent: The surgeon threads the stent into the femoral artery through a tiny incision made in the skin in the groin. The replacement valve is pushed gently through the artery to the heart via the stent, which is expanded with the inflated balloon so the diseased valve can be implanted. The heart's pumping is restored by electric shock, and the patient is hospitalized for about five days. A full recovery can take a few weeks - considerably quicker than with open-chest surgery. The great advantages of using a catheter - like with angioplasty (balloon therapy) to open clogs in the coronary arteries - instead of an open-chest operation include minimal blood loss, fewer side effects and days in the hospital, a reduced risk of infection and better cosmetic results. Performing minimally invasive surgery to replace diseased heart valves on thousands of Israelis a year could save the health system a lot of money, as well as improve the quality of life for patients. In addition, the minimally invasive technique may be a good option for patients who need aortic-valve replacement and are unable to have open-chest surgery due to their poor overall health or life-threatening conditions. The minimalistic technique would not be not suitable for every patient with a diseased valve, including the obese, those with atherosclerosis (clogged arteries), or high-risk elderly patients. Financial experts predict that the transcatheter valve market in the US alone could reach $850 million by 2012. Unlike angioplasty to remove clogs in the coronary arteries in which patients are awake, those undergoing valve replacement are put under general anesthesia. Stenosis (narrowed valves) or regurgitation (valves that fail to close properly and allow blood to leak back in the wrong direction) are some of the types of valvular heart disease that can be repaired by minimally invasive surgery. The technique is usually carried out on the mitral valve or the aortic valve. The mitral is located between the upper-left chamber (left auricle) of the heart and the lower-left chamber (left ventricle), while the aortic valve is between the left ventricle and the aorta.