Internationally Recognised Endoscopic Heart and Lung Surgeon | Joseph Zacharias

Endoscopic Cardiac Surgery

Tips, Tricks and Traps

by Joseph Zacharias

This book is unique in describing the practical considerations of endoscopic cardiac surgery. It covers this topic from basic concepts such as patient selection to imaging and outlines the different approaches to particular endoscopic cardiac surgical procedures. As there is an increasing acceptance that cardiac surgery needs to be provided to older and sicker patients and more asymptomatic patients, the option of a sternotomy is becoming less appealing. The endoscope has changed the patient pathway in many surgical specialities, but until recently cardiac surgery has been slow to adopt this approach. With improvements in imaging and better imaging technology, there is a steady increase in accepted procedures and trained surgeons offering this approach.

Endoscopic Cardiac Surgery - Tips, Tricks and Traps by Joseph Zacharias

Consultant Cardiothoracic Surgeon

Joseph Zacharias

Joseph Zacharias is a Consultant Cardio-Thoracic Surgeon working at the Lancashire Cardiac Centre in Blackpool and the Alexandra Hospital in Manchester. He has been a leader in introducing patient centred endoscopic minimal access procedures for patients needing both heart and lung surgery over the past 18 years.

Mr Zacharias has one of the largest experiences in the UK of Endoscopic heart valve procedures and has extensive teaching experience having helped over 20 surgeons from all over Europe start minimally invasive or endoscopic heart valve surgery programs. He has published extensively on the safety of endoscopic conduit harvesting and recently published excellent ten year results using this technique. He is involved in high quality research on endoscopic heart valve surgery and is frequently invited to speak at educational events.

Consultant Cardiothoracic Surgeon | Joseph Zacharias
Consultant Cardiothoracic Surgeon | Joseph Zacharias

Vertical Tabs

Endoscopic mitral valve surgery

Traditional mitral valve surgery is performed through a long incision down the midline (sternotomy) which has served the speciality well over the past 50 years.  Over the last 15 years, an increasing number of surgeons have moved to minimally invasive (key hole / endoscopic), non sternotomy incisions to approach the heart valves.  Two teams, one in Aalst led by Hugo Vanerman and another in Leip

Anterior right thoracotomy for aortic valve replacement

Aortic valve replacement surgery is the most commonly performed heart valve procedure.  Prior to surgery, common symptoms reported by patients include shortness of breath, chest tightness, light headedness and tiredness.

Endoscopic tricuspid valve surgery

The tricuspid valve is often referred to as the 'forgotten valve' by both cardiologists and cardiac surgeons.  However, as more research is being completed, there is now increased awareness of the importance of early intervention to treat any difficulties with this valve.  Mr Zacharias and his team have the largest experience of endoscopic tricuspid valve repair or replacement and have presente

Endoscopic redo heart valve surgery

Over the past 20 years, a sternotomy (key hole) has been the most common surgical approach for patients presenting with deterioration of their heart valve over time.  Typically, the deterioration is identified during an echocardiogram.  Patients present with shortness of breath, tiredness and/or swelling of their legs. 

Other Endoscopic procedures (Atrial Fibrilation, ASD closure and HOCM surgery)

The endoscopic (key hole) approach is very versatile and can be used for treating other rare conditions too.  The most common other endoscopic operation is the treatment of Atrial Fibrillation (AF).  Patients with this condition presents with a fast, irregular heartbeat (palpitations).  Specialist cardiologists (Electrophysiologist) routinely treat this.

Coronary Artery Bypass Grafting (CABG)

Traditionally, veins are removed from a patient's leg which involves long incisions from ankle to groin.  Since 2008 Mr Zacharias was one of the first surgeons in the UK to pioneer an endoscopic (key hole) vein harvesting t



BHVS Deep Dive Session 2024
30 Apr, 2024
Norwegian Spring Cardiac Surgery Conference April 24
26 Apr, 2024

Why bother with MICS?

ReEvolution Summit, Houston, Texas, 2024
25 Jan, 2024
8th Annual Conference BISMICS
05 Dec, 2023

Years as a consultant


Heart & Lung cases


Endoscopic cases

< 2%

conversion to sternotomy rate


Mr Zacharias has many publications in international peer reviewed journals on both heart and lung surgery and continues to review, learn and teach from his work and by collaborating with others nationally and internationally.


If a picture speaks a thousand words how much more useful are operative videos? Mr Zacharias has many of his operative videos presented to the wider cardiac surgical community in order to share good practice.

Invited Lectures

With a passion for teaching and training Mr Zacharias is a sought after speaker at national and international conferences. The lectures are often regarding complex procedures or on safe adoption of new techniques.

I can never repay you for what you have done for me. thank you from the bottom of my heart for looking after me so well. Many many thanks.


Dear Mr Zacharias,
Thank you doesn’t seem enough for all you and your brilliant team have done for me, not once but twice. Also special thanks to all staff for the compassion and kindness shown to me.


To Mr Zacharias
I just wanted to extend my thanks and appreciation to you for having performed my surgery.
Hopefully, Lord willing, I won’t require any more treatment, but if and when I do, would be happy to be back under your care.
I’ve always found you to be a kind and caring man and sincerely wish you every best wish for the future.


You are right its about teamwork, but the most important part of a team is its leader! I know excellence, technical ability and common sense when I see it and when applied with compassion and care it adds up to something special. It was a privilege to be your patient. I will always be grateful.


Dear Mr Zacharias,
Just to say thank you so much after my AVR. Thank you is not enough really, I am so grateful for the chance I have been given, as the surgery was a great success. I feel a lot more energetic & "just like” a 20-year-old! You are just amazing Sir!.


What can I say, what can I do, but simply say a big Thank You!


Please accept my sincere thanks for the treatment and friendly atmosphere conveyed to me during my six days stay in Blackpool Victoria Hospital last month. I will be forever grateful and would advise you all that I am making a quite rapid recovery from my operation.


To Mr Zacharias
Thank you for your care and attention. A Million thank you is not enough here is another one! Thank you!


Dear Mr Zacharias, we would like to thank you very much indeed for all you have done in carrying out D's bypass operation, for all your care and excellent expertise and that of all your team at the Lancashire Cardiac Unit. We are both very grateful!

D & A O

Dear Mr Zacharias
This is just a short note to express my appreciation for all you did for me during my recent stay at Blackpool Victoria.
You not only kept me alive, but you were extremely sensitive to my day-to-day changes in circumstances, culminating in a timely and appreciated discharge.
It was indeed humbling to recognize just how many highly qualified professionals worked very hard to keep me, unworthy and unknown to them, ticking over.
Thank you profusely.


To Mr Zacharias and his team. Thanks for the excellent care and attention before and after my lung operation. Thanks again.


Mr Zacharias
We would like to thank you and your team for the wonderful first-rate treatment I received under your care. Carry on the good work!


Thank you for everything and looking after me. Wouldn't be here now if your team hadn't been there.


You are all the most professional, kind and serving people I have ever met, if it was not for all of you and your skills I would not be here now. You really are a wonderful team and I thank you all for being there for me. 


To Mr. J Zacharias
Just a quick line to say a massive “Thank you so very much” for your and your teams amazing surgery. I am so grateful to have had a repair and not a replacement on my valve.
Your needlework was also amazing!
You all do a fantastical job.
Many many thanks


I am most grateful for what you did for me and always will be. It isn't just your ability in theatre, which is second to one, but the manner in which you treat patients before and after. So please take good care of yourself.


To Mr. Zacharias
Thank you for your kindness and consideration whilst caring for me on my recent visit to Blackpool.
It is much appreciated and I am thankful that you give so much dedication to your patients.
Enjoy a glass of wine on us and hopefully we won’t need to see you again professionally for a long time.
Thanks again. yours M.H
P.S Thanks for the nice scar


Your Professional care both in surgery and on the wards after has been the best I could have wished for. Yours sincerely,


To Mr. Zacharias
Thank you very much for giving me a new life, God bless your brains and your hands.


With many thanks and eternal gratitude to you and the whole team, following my very successful fourth heart valve replacement operation.


Dear Mr Zacharias
I would like to take this opportunity to thank you and your team for looking after me when I had my operation.
I am so grateful to you for giving me a new lease of life, the care that I received from yourself and your staff was outstanding, I always felt comfortable that I was in good hands, you are all a credit to your professions.
Once again thank you very much for your help.


Thank you for everything Joe. My only complaint is that you underpromise and over deliver. Please work on that!


Thank you so much for your wonderful care and expertise.
Thank you to each and every one of you.


You and your team worked some magic on my heart, 5 years ago, and thanks to you I'm still here!


Mr Zacharias,
I have few angels in my life, you have become one of that few.
Your confidence and assurance in your ability shone through and gave me courage to go forward when I started to “wobble.”
I thank you and promise to take great care of myself to protect your gift.


I write to make you aware of the splendid treatment I recently received during my time in the Lancashire Suite within the Lancashire Cardiac Unit of your hospital and to ask you to convey my thanks to all the staff concerned.
I found Mr Zacharias to be a totally committed, extremely skilled and knowledgeable surgeon with a deep understanding of the needs of his patients.


Just wanted to say thank you so much for not only fixing my dodgy lungs but making me feel at ease about the whole experience. You are all so incredibly talented and lovely and I hope the world wakes up and gives you the pay rise you deserve!


In July 2018 you performed a surgical ablation which successfully stopped my Atrial Fibrillation. I have thanked you in my thoughts so many times, as since then I have had no recurrence of the problem and I thought i would write to you to say how very grateful I am to you 5 years later.


Thank you for giving me back my life. You will always be part of my prayers.


To Mr Zacharias and all the staff in cardiac, I would like to say a big Thank you, for all your hard work and care and attention you gave me on my stay. 


I would like to take this oppurtunity to thank Mr Zacharias and his team for giving me a second chance, and all the hard work they put into fixing me. I will always be grateful for that. The team was absolutely fantastic. Thank you so much.


Dear Mr Zacharias,
Just wanted to say a “MASSIVE THANK YOU” for everything that you’ve done for me! For seeing me when I was rushed in as an emergency, for squeezing me into surgery. Just “thanks” for everything! I am grateful and appreciate everything!


Dear Mr Zacharias,
I am writing to thank you for the splendid way you looked after me during my recent illness.
From the start you made my wife and I feel comfortable and inspired us with confidence and able to cope during this traumatic period. I am grateful to you for the amount of time you devoted to my case particularly as you were so very busy during my time on the ward.
I am pleased to say that I now feel well on the road to recovery and that I am feeling stronger every day.
Thank you once again for everything you have done for me; I can now look forward in confidence to a healthier and longer active life.


"Thank you so much for all you have done for me. Your care and professionalism has been outstanding and I can not thank you enough! I will be forever grateful and humbled that not only have you saved my life but done it in such a caring way".


Words cannot begin to express our thanks and gratitude for all that you have done for M. Thus, thank you for your care and support during this difficult time. We are blessed to have such a skilled, knowledgeable and caring surgeon and team.
An immense thank you for the surgery and it's success! It will never be forgotten. You will always be remembered.


Dear Mr Zacharias
Thank you so much for everything you have done for my husband.
You are highly motivated, hardworking and dedicated to your work.
Thank you again.


" Thank you so much for guiding me through the appointments and the process of everything. I am thankful for your hardwork and efforts".


Dear Dr Zacharias,
This is a personal thank you for your dedication and commitment you have to working for the NHS.
J. came into hospital for a replacement heart valve, his recovery has been amazing and this can only be down to you and the team of people involved in his care. I will be forever grateful that you were the Dr assigned to his care.


Thank you is said in a million ways but never have they meant more than they do today. Thank you.


Your health is my priority

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Endoscopic Cardiac Surgery - Tips, Tricks and Traps by Joseph Zacharias

This book is unique in describing the practical considerations of endoscopic cardiac surgery.

Scars with Sternotomy or Endoscopic heart valve surgery

Patients contemplating Heart valve surgery often have many questions.

Mr Joseph Zacharias is a Consultant Cardio-Thoracic Surgeon who over the past 18 years has introduced many patient centred procedures and reviewed, presented and published his excellent results. He is passionate about teaching and training and continues to help disseminate his learning and skills to doctors at all levels of training. Mr Zacharias has one of the largest experiences in endoscopic heart surgery in the UK and continues to maintain a busy practice in both complex heart and lung surgery.


Consultant Cardiothoracic Surgeon | Joseph Zacharias

Alexandra Hospital Mill Lane, Cheadle, Manchester

0161 495 7008


Private secretary: lesley.wilson3@circlehealthpartners.co.uk