Minimally Invasive Cardiac Surgery

The preferred method is minimally invasive surgery, which enables the doctors on the medical staff of the heart hospital to carry out difficult cardiovascular procedures without requiring open-heart surgery.

Minimally invasive techniques were initially utilized as a surgical treatment option for patients who were deemed too frail for open-heart surgery, but they have since become standard practice for patients who require heart surgery. Several of the widespread minimally invasive procedures were invented by the surgeons on our medical staff.

The major objective is to provide excellent surgical results. When feasible, doctors treat cardiac diseases minimally invasively to help their patients feel well more quickly. With this method, you can frequently avoid conventional invasive surgical treatment. Smaller incisions are required during minimally invasive cardiac surgery, which could lead to:

• Shorter stays in the hospital
• Less bleeding
• Surgery pain is reduced
• Little (or no) scarring
• More rapid return to normal activity
• Fewer complications
• Reduced risk of infection

Why minimally invasive?

Doctors have a strong interest in these novel methods. The effectiveness of minimally invasive surgery has been supported by evidence that has appeared in numerous international publications.

When carried out routinely by surgeons skilled in these operations, research has demonstrated that these treatments are safe. Benefits include a shorter hospital stay and a lower risk of transfusion need due to decreased bleeding. Additionally, patients have less discomfort, quicker recovery from surgery, and a lower chance of wound infection. Naturally, they also have considerably smaller scars.

Although the length of time patients need to recover in the hospital after surgery may not be much reduced by minimally invasive surgeries, both the patients and the cardiologists caring for them thereafter notice the difference.

Compared to patients who have had traditional surgery, they have more energy, can achieve more, and feel better faster. They can walk farther, pick up hobbies more quickly, get active, and get back to work more rapidly. When compared to patients who have undergone traditional open-heart surgery, this is far better.

Patients do not need to take blood-thinning medications for the remainder of their lives thanks to the new generation of minimally invasive procedures, many of which use heart valves manufactured from animal tissue rather than the traditional mechanical valves.

Patients may experience problems when taking warfarin and similar drugs. For instance, if they require more surgery, they will need infusions of other medications to counteract the drug's thinning effects.

Warfarin is not recommended for those who want to become pregnant since it increases the likelihood that a bump or accident will be more serious than it has to be. This can limit the hobbies and activities that people choose to engage in. The most recent methods and tools eliminate this risk, giving patients more independence.

In general, doctors examine patients' overall fitness, eligibility for the treatment, and, of course, their requests when deciding whether to do minimally invasive surgery on them. You don't need to be young, either, as doctors frequently have excellent results while operating on patients in their 80s and 90s.

How Does Minimally Invasive Cardiac Surgery Differ?

The minimally invasive procedure entails the surgeon making numerous small incisions between the ribs as opposed to one large cut and cutting the breastbone. The surgeon can carry out the treatment with accuracy thanks to a specific surgical device with a camera and other surgical equipment connected. The following operations can be performed with minimally invasive cardiac surgery:

• Aortic valve repair
• Mitral valve replacement
• Coronary bypass
• Ventricular assist device
• Atrial septal repair
• Tricuspid valve repair

Although most patients can have minimally invasive cardiac surgery, only you and your physician can decide which method is best for your case.

Minimally Invasive Cardiac Surgery Benefits

The following five benefits of minimally invasive cardiac surgery:

• Fewer pain. Health care professionals give postoperative pain and discomfort management priority since open-heart surgery necessitates a significant incision and breaks the breastbone. To help patients manage discomfort, doctors frequently recommend medications. Patients who undergo minimally invasive cardiac surgery have significantly less postoperative discomfort because it doesn't need cutting the breastbone and instead makes small incisions.
• Fewer scars. When you recover from open-heart surgery, you can anticipate having a noticeable scar in the center of your chest. Contrarily, individuals who undergo minimally invasive cardiac surgery experience significantly less scarring and better cosmetic outcomes.
• Faster recovery. Heart surgery that is minimally invasive results in less physical stress. Because of the tiny cuts and the fact that the breastbone was not cut, patients recover more quickly in days instead of weeks. In comparison to open-heart surgery, patients can resume their regular activities and jobs significantly sooner.
• Shorter hospital stay. The average recovery time for patients who choose minimally invasive cardiac surgery is 2-5 days, as opposed to 8-10 days for patients who choose open-heart surgery.
• Lower complication risk. Open-heart surgery carries the risks of infection and bleeding. The minimally invasive method carries the same risks, although there is a lesser likelihood of these consequences. Which operation is ideal for you depends on a variety of factors. When making a recommendation, your surgeon takes into account your age, general health status, and medical history.

Minimally Invasive Mitral Valve Repair

A little flap in the heart called the mitral valve prevents blood from flowing in the wrong direction. Leaky mitral valves can significantly reduce the quality of life and life expectancy since they can lead to fatigue, shortness of breath, and heart failure in some cases. Comparing the US to other equivalent countries in Europe, the rate of mitral valve repair is the lowest.

Traditionally, the breast bone is cut 20 to 25 centimeters through to repair the mitral valve. Doctors make a small incision to repair the mitral valve utilizing minimally invasive methods and the right side of the chest is cut by five centimeters, allowing access to the area between the ribs and the heart.

This gives me a great vantage point with a high-definition video camera. The statistical likelihood of having a stroke is 0.05%, and the mortality risk is less than 2%, with the promise of fantastic long-term results.

Minimally Invasive Aortic Valve Replacement

Due to narrowing or regurgitation, where the valve doesn't shut properly, an aortic valve replacement may be necessary. The aortic valve controls the flow of oxygen-rich blood from the heart into the main bloodstream in a healthy heart. Three triangular-shaped flaps that come together nicely make up the aortic valve.

The flaps extend to let blood flow into the artery and then retract to stop regurgitation. However, the valve could deteriorate with time or develop calcium deposits that render it ineffective.

Pumping blood throughout the body requires more effort from the heart. Chest pain, shortness of breath, and fainting are some of the symptoms that might ensue; if left untreated, they can cause heart failure and death.

Mechanical valves have historically been used to replace worn-out aortic valves, but this invasive procedure requires patients to take warfarin for the rest of their lives. Innovations like the Inspiris Resilia valve are also giving patients fantastic outcomes. Compared to conventional animal tissue valves, which need to be changed every eight to ten years while having benefits over mechanical valves, it appears that this valve will live longer.

It uses revolutionary anti-calcification technology and is constructed from cow pericardium tissue, which prevents the valve from stiffening and being damaged, extending its lifespan.

All of these benefits are also present in the new Edwards Intuity valve, which is likewise constructed from cow tissue. It doesn't require stitches because of a fibrous ring at the base of the area where the original valve was holding it in place. The stainless-steel stent (tube-like mesh) that holds the new valve under the fibrous ring is attached to it. Because they outlast earlier animal tissue valves, these innovations are game-changers.

CABG and Endoscopic Vein Harvesting

In coronary artery bypass surgery, blocked or narrowed coronary arteries are replaced with veins, typically taken from the patient's leg. It is linked at one end to the point where the body's major artery leaves the heart. Below the blocked or restricted area of your coronary artery, the opposite end is joined. The blood supply to the heart is improved because it avoids blockage or narrowing.

A beating heart or a cardiopulmonary bypass machine can be used to perform the CABG surgery. Traditional vein harvesting from the leg has drawbacks, including the potential for infection at the site and substantial leg scarring.

Just over ten years ago, Dr. Toufan Bahrami became the first surgeon in the UK to consistently utilize endoscopic vein harvest (EVH), bringing it to Harefield. This makes it possible to extract the vein with a little one-centimeter incision as opposed to a cut that is nearly a meter long. The vein is then precisely the same way used as a transplant.

All CABG procedures there are carried out in this way. Patients now experience less pain, have shorter hospital stays, and have higher levels of patient satisfaction as a result. Infection rates using the EVH approach were reduced from up to 25% using conventional methods to only 3%, according to one research.

Minimally Invasive Cardiac Surgery Procedure

Robotic heart surgery, thoracoscopic surgery, and chest surgery through a small cut are all examples of minimally invasive cardiac surgery (direct less invasive access heart surgery). In each type, doctors make a tiny incision between your chest ribs to access your heart.

The surgeon uses a tool with a tiny video camera introduced via one of the incisions to assist in viewing inside your body. Similar to open-heart surgery, the majority of minimally invasive procedures employ a heart-lung bypass machine. Throughout the process, the machine keeps blood flowing through your body.

Robot-assisted heart surgery. When doing open-heart surgery with robotic assistance, the surgeon utilizes robotic arms rather than his or her own hands to carry out the exact movements. Your surgeon works at a remote console while doing this treatment, viewing your heart on a video monitor in a magnified, high-definition 3D image. Your surgeon's hand gestures at the console are accurately translated to the operating table's robotic arms, which move identically to a human wrist. At the treatment table, a second surgeon and the surgical team assist by switching out the surgical devices attached to the robotic arms.

Thoracoscopic surgery. In thoracoscopic surgery, also known as a mini-thoracotomy, your doctor makes a small cut in your chest and inserts a long, thin tube called a thoracoscope that houses a tiny video camera. Long devices that are introduced through tiny incisions between your ribs are used by your surgeon to repair your heart.

Postoperative Care

Typically, you'll stay in the intensive care unit (ICU) for one to two days. Through intravenous (IV) lines, fluids and drugs will be administered to you. Other tubes inserted during surgery will drain blood and fluid from your chest as well as urine from your bladder. Oxygen may be administered to you via a face mask or nasal cannula.

You will be transferred from the ICU to a regular hospital room after a few days. Your condition and the nature of your surgery will determine how long you stay in the ICU and hospital. Your medical staff will:

• Keep an eye on your health and look for any symptoms of infection around your incision sites.
• Keep an eye on your respiration, pulse rate, and blood pressure.
• Help you in pain control
• Get you moving and provide you with instructions to progressively improve your activity levels.
• Encourage you to cough to keep your lungs clear and demonstrate how to perform deep breathing exercises for you

During your recovery, your surgeon will provide you with guidelines to follow, such as keeping an eye out for signs of infection, taking care of your incisions, taking medication, and managing discomfort. When you can resume regular activities like working, driving, and exercising will be determined by your surgeon.

Minimally Invasive Cardiac Surgery Outcomes

Your quality of life may increase and aortic stenosis symptoms may be lessened with minimally invasive cardiac surgery.

To keep an eye on your heart health, you'll often need to visit your doctor frequently. Your heart's health may be tested.

A heart-healthy lifestyle, which entails living a balanced diet, working out, managing stress, and abstaining from tobacco use, may also be advised by your doctor. Cardiac rehabilitation is a tailored course of instruction and exercise intended to enhance health following heart surgery.

Minimally Invasive Cardiac Surgery Risks

Your doctor will talk to you about the risks of surgery. In general, the complications of minimally invasive coronary artery bypass are lower than with open coronary artery bypass surgery. Risks related to any surgery include:

• Blood clots in the legs may travel to the lungs
• Blood loss
• Breathing problems
• Heart attack or stroke
• Infection of the lungs, urinary tract, and chest
• Temporary or permanent brain injury

Possible risks of coronary artery bypass include:

• Memory loss, loss of mental clarity, or fuzzy thinking. This is less common in people who have minimally invasive coronary artery bypass than in people who have an open coronary bypass.
• Heart rhythm problems (arrhythmia).
• Infection of a chest wound. If you are fat, have diabetes, or have previously undergone coronary bypass surgery, this is more likely to occur.
• Chest pain and low-grade fever, collectively known as a postpericardiotomy syndrome, can continue for up to 6 months.
• Pain at the cut's site.
• During surgery, it may be necessary to switch to a traditional method with a bypass machine.

Conclusion

Rather than cutting through the breastbone as is done in open-heart surgery, minimally invasive cardiac surgery entails making small cuts in the right side of the chest to reach the heart between the ribs. Several different cardiac problems can be treated using minimally invasive heart surgery. This kind of surgery may result in less discomfort and a faster recovery for many patients than open-heart surgery.