Minimally Invasive Heart Surgery: Treating Heart Diseases With Minimal Touch

10 May,2024

Heart patients and their families often struggle to go through the complex cardiology field. Fortunately, cardiovascular care has significantly advanced recently, with new techniques and technologies emerging. These breakthroughs have led to the development of minimally invasive heart surgeries or minimally invasive cardiac surgery (MICS). 

From corrective surgeries for arrhythmias and defects to valve replacements and repairs, MICS allows surgeons to perform various heart surgeries through small incisions with specialized instruments. It is a gentler and less invasive surgical experience that benefits patients of all ages. Even elderly and frail patients can benefit from MICS, enjoying better outcomes and a quicker recovery.

What is Minimally Invasive Heart Surgery?

Ignoring heart problems can lead to heart attack or heart failure. It can be fatal if not treated. Therefore, when cardiologists cannot correct heart-related issues through medication, heart surgery remains the only option. It should be sought without delay. 

The latest technique for heart surgery is minimally invasive cardiac surgery (MICS). As the name suggests, it is minimally invasive, meaning the procedure is carried out through one or more small incisions. 

During minimally invasive heart surgeries, surgeons use small, high-powered cameras, tools, and robotic arms that are inserted through the incisions. The surgeon then guides these tools between the ribs to access the heart. Compared to open-heart surgeries, minimally invasive heart surgeries lead to less scarring, reduced pain, and quicker healing times. Open-heart surgeries, by contrast, usually involve cutting through the breastbone to reach the heart.

What are the Different Types of Minimally Invasive Heart Surgery?

Cardiac surgeons are well-versed in treating many heart conditions using minimally invasive techniques. Robotic heart surgery and thoracoscopic surgery are the two most common types of minimally invasive heart surgery. 

• Robotic heart surgery utilizes robotic arms to perform the procedure minimally invasively. The cardiac surgeon operates the robotic arms from a nearby computer station. They perform the surgery while looking at a magnified 3D view of the heart on a monitor. As they move their arms and wrists, the robotic arms move in the same way to perform the surgery. The surgical team at the operating table changes the specific tools attached to the robotic arms as needed.
• In thoracoscopic surgery, also known as minithoracotomy, the surgeon makes a small incision between the ribs in the chest. They then insert a thoracoscope (a long tube with a video camera attached to it) through the incision. The surgeon repairs the heart defects using instruments placed through small incisions between the ribs.

Which Procedures Can Be Performed Using Minimally Invasive Heart Surgery?

Cardiac surgeons use advanced technologies to perform a wide range of minimally invasive surgeries. Common minimally invasive cardiac surgeries include –

• Mitral Valve Repair or Replacement: Surgical procedure to repair or replace a damaged mitral valve in the heart
• Atrioventricular Canal Defect Surgery: Surgical procedure to repair a congenital heart defect affecting the heart's valves and septum
• Coronary Artery Bypass Surgery (MIDCAB, MICAS): Surgical procedure to bypass blocked or narrowed coronary arteries
• Atrial Septal Defect (ASD) Repair: Surgical repair of a hole in the wall between the heart's two upper chambers (atria)
• Tricuspid Valve Repair or Replacement: Surgical procedure to repair or replace a damaged tricuspid valve (the valve controlling the flow of blood between the right atrium and ventricle)
• Total Arterial Revascularisation: Procedure to improve blood flow to the heart by bypassing narrowed/blocked coronary arteries. Arteries from other parts of the body are used for this procedure.
• Maze Procedure for Atrial Fibrillation: The procedure involves making scar tissue in the heart to redirect electrical signals and restore a normal heartbeat
• Ventricular Assist Device Placement: A surgical procedure to implant a device that helps the heart with pumping blood. Often, it is a temporary measure for people waiting for a heart transplant.

Who is a Good Candidate For Minimally Invasive Heart Surgery?

Minimally invasive heart surgery has better outcomes and lower risk of postoperative complications. However, it is only suitable for some. Your heart specialist will decide the best approach for your treatment. They will carefully evaluate various factors before finalizing if MICS is an option for you. These factors include –

• Age
• Heart condition
• Type of heart disease
• General well-being
• Lifestyle
• Past heart surgeries
• Medical history

Patients with symptoms such as persistent chest pain, dizziness, shortness of breath, fatigue, and pain in the left arm or shoulder are good candidates for minimally invasive cardiac procedures. 

Surgeons use minimally invasive cardiac surgery to treat a variety of conditions. These include –

• Coronary Artery Disease: blockage or constriction of the coronary arteries (the arteries responsible for supplying blood to the heart)
• Congenital Heart Disease: structural problems with the heart that are present at birth
• Valvular Heart Disease: a condition or damage affecting one or more heart valves
• Atrial Fibrillation: an irregular heartbeat and rhythm that originates in the upper chambers (atria) of the heart
• Atrial Septal Defect: a condition in which there is a hole in the wall that separates the atrium
• Cardiac Tumors: which are irregular growths that form in the heart tissue
• Aortic Disease: a condition affecting the largest artery that carries blood throughout your body

What are the Preparations Done for Minimally Invasive Heart Surgery?

Planning for a minimally invasive heart surgery can be overwhelming, but your care team is there to help you every step of the way. They will provide valuable information about the entire process, including what to expect before, during, and after the surgery.

• The healthcare team will explain the benefits and risks of the procedure.
• Before your surgery, it's a good idea to talk with your caregiver about the kind of assistance you'll need when you return home. It will ensure that you receive the necessary support during your recovery.
• It's also crucial to inform your healthcare team about any allergies or medications you're taking, including those bought without a prescription.
• Make sure to ask them about the right time to take your regular medicines before surgery and when you should stop eating or drinking before the procedure.

How is Minimally Invasive Heart Surgery Performed?

Minimally invasive heart surgery is done at specialized cardiac surgery hospitals. The surgery involves the following steps – 

• You'll be given general anesthesia to be completely unconscious and pain-free during the surgery.
• The surgeon makes one or more small incisions, typically between the ribs on the left side of the chest.
• A small camera is inserted through the incisions to provide a magnified view of the heart on a monitor in the operating room.
• Depending on the type of MICS, long, slender surgical instruments or robotic arms are inserted through other incisions to perform the required procedure on the heart.
• The following surgery steps will vary depending on the heart condition being addressed. For example, it could involve repairing or replacing a heart valve, performing a coronary artery bypass graft (CABG), or correcting a heart defect.
• Once the procedure is complete, the surgeon carefully removes the instruments and camera.
• They then close the incisions with sutures or steri-strips.

What Happens After a Minimally Invasive Heart Surgery?

• After minimally invasive cardiac surgery, the medical team will transfer patients to the Cardiac Intensive Care Unit (CICU) for one to two days. 
• Doctors may insert drainage tubes into the chest to prevent fluid buildup around the heart. 
• Afterward, patients move to a general room of the hospital to continue their recovery for a few days. 
• The medical team will encourage patients to stand up and walk during this time. They may also suggest breathing exercises to prevent fluid from entering their lungs. 
• The period of hospital stay depends on the patient's condition and surgery type. However, most patients stay for 2-5 days. 
• Your healthcare team will put you on a cardiac rehabilitation program, which will help you recover better.
• Patients undergoing minimally invasive heart surgery recover within 2 to 4 weeks.

What Benefits Does Minimally Invasive Heart Surgery Offer?

Compared to open heart surgeries, where a 10-15 inch incision is made through the breast bone, minimally invasive cardiac surgery is a better option. The incision size for MICS is 2-5 inches. It offers several benefits such as – 

Less Pain

• Open-heart surgery, while effective, involves a large incision and breastbone breaking, which can cause significant pain. 
• However, minimally invasive heart surgery is a less painful alternative that uses small incisions and avoids cutting the breastbone. 
• This approach helps patients experience much less pain following the procedure.

Less Scarring and Faster Recovery

• Another benefit of minimally invasive heart surgery is that it causes less scarring, which improves the patient's cosmetic appearance. 
• Moreover, it is less traumatic to the body, which means patients heal in days instead of weeks after open-heart surgery. 
• It allows patients to return to regular activities and work much sooner, improving their quality of life.

Shorter Hospital Stay and Lower Complication Risk

• Lastly, people who opt for minimally invasive heart surgery typically have shorter hospital stays, usually around 2-5 days, as opposed to the 6-8 days associated with open-heart surgery. 
• Although risks such as infection and bleeding still exist, the chances of experiencing such complications are lower with the minimally invasive approach.

To Conclude

Heart surgery is a significant procedure that can cause pain and discomfort for patients. Fortunately, options are available to minimize these adverse effects and help patients recover faster. Minimally invasive heart surgery is a promising alternative that offers numerous benefits for patients. Healthcare teams can work with patients to determine the best course of action, ensuring a safe and effective procedure that meets their needs.