Heart valve surgery. Image 2 of 2. Artificial heart valve (red rim partially seen in hole) being pulled into position with sutures. The hole is between two of the patient's ribs. The metal clamp (seen screwed through the chest wall) is used to stabilize the area being operated upon. Suction tubes (lower right) mop up blood, and soft-tissue retractors hold open the hole. The valve will replace a defective heart valve. This is keyhole heart surgery. It is less traumatic than open heart surgery (where the rib cage is opened). For a view of the valve in position outside the hole, see image M561/078.