Minimally Invasive Heart Surgery

What is Minimally Invasive Heart Surgery?

Heart (cardiac) surgeries are traditionally performed through an open method, where a long incision of 6 to 8 inches is made down the chest, and the breastbone (sternum) is separated to expose the heart. Minimally invasive heart surgery does not require splitting of the breastbone, rather it is performed through small incisions on the side of the chest between the ribs using a scope and special surgical instruments.

Minimally invasive cardiac surgery includes robotic-assisted cardiac surgery, thoracoscopic surgery, and direct less invasive access heart surgery (surgery through a small incision in the chest). In all the types of minimally invasive procedures, your surgeon will reach your heart through tiny incisions between the ribs of your chest.

Benefits of Minimally Invasive Heart Surgery

Minimally invasive heart surgery provides various benefits against traditional open method including:

• Smaller scars
• Decreased risk of infection
• Less bleeding
• Reduced requirement of transfusion
• Less post-operative pain
• Fast recovery
• Shorter hospital stays
• Quicker return to daily normal activities

Anatomy of the Heart

The heart is a fist-sized muscular organ that works around the clock, pumping blood to various parts of the body. It is located between the right and left lungs in the middle of your chest, and is covered by a three-layered, fluid-filled sac called the pericardium. 

The heart has four muscular chambers, the upper two chambers are called the right and left atria, and the lower two chambers are called the right and left ventricles. With the help of blood vessels called arteries and veins, the heart and its chambers pump blood, supplying oxygen and nutrients to all parts of the body and collecting carbon dioxide and wastes from the body for purification.

Types of Minimally Invasive Heart Surgery

Several types of cardiac surgeries can be performed through a minimally invasive approach, including:

• Aortic valve replacement
• Mitral valve repair or replacement
• Atrial septal defect and patent foramen ovale closure
• Tricuspid valve repair or replacement
• Coronary artery bypass surgery
• Atrioventricular septal defect surgery
• Maze procedure for atrial fibrillation

Indications for Minimally Invasive Heart Surgery

Your surgeon may recommend minimally invasive heart surgery for the treatment of cardiac conditions such as:

• Coronary artery disease
• Heart failure
• Plaque buildup in the arteries
• Faulty heart valves
• Abnormal heart rhythms
• Diseased or dilated major blood vessels (such as the aorta)

Preparation for Minimally Invasive Heart Surgery

Preoperative preparation for minimally invasive heart surgery may involve the following steps:

• A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
• You should refrain from alcohol or tobacco at least a few days prior to surgery.
• You should not consume solids or liquids at least 8 hours prior to surgery.
• A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Minimally Invasive Heart Surgery

Minimally invasive heart surgery is performed under general anesthesia. Depending on the type of surgery, a few small incisions of approximately 3 to 5 cm may be made on your chest. You are connected to a heart and lung machine which performs the normal function of the heart during the surgery.

Robot-assisted minimally invasive heart surgery: The robotic system consists of a surgeon’s console, a patient-side cart with interactive robotic arms, a high-performance vision system (3D camera), and miniaturized surgical instruments. Through small incisions on the chest, your surgeon inserts an endoscope (a flexible tube with a small camera at the end) and other instruments. These instruments are held by robotic arms that are controlled by your surgeon at the console. The surgeon’s every move (of hands and wrists) is recognized by a computerized system that manipulates and translates them into corresponding scaled and accurate movements that are mimicked by the robotic arms. With the help of the endoscope, your surgeon can clearly view the treatment area as 3D images on a computer screen. With the help of the other surgical instruments, your surgeon exposes the treatment area and performs the required repair to enable its normal functioning.

Minimally invasive thoracoscopic surgery: In this surgery, a thoracoscope – a thin, long tube with a tiny high-definition video camera at the end – is inserted through a small incision between your ribs. The thoracoscope guides your surgeon visually through the surgery by projecting the internal images onto a monitor. Your surgeon then uses small surgical instruments inserted through the other tiny incisions on the chest to perform the required repair. Once the surgery is completed, drains are placed, the incisions are closed, and you are taken to the intensive care unit for monitoring.  The drains are removed a day or two after the surgery.

Post-Operative Care

Following the surgical procedure, you may experience pain or discomfort for which your surgeon may prescribe medications. You may be allowed to go home after 2 to 3 days. You can usually resume normal activities and return to work within 2 to 4 weeks after the surgery. Refrain from strenuous activities and lifting heavy weights for a defined period. Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided. To maintain a healthy heart, you will be advised to take your prescribed medications and make a few lifestyle changes like quitting smoking, exercising regularly, maintaining a healthy weight, and eating a healthy diet. A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Minimally invasive heart surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Blood clots
• Stroke
• Heart rhythm problems
• Damage to adjacent tissues or organs
• Death (rarely)