Minimally Invasive Cardiac Surgery

Cardiac surgeries are mostly performed by the process of sternotomy. It involves splitting the entire breastbone. Now with innovation and advancement in medical sciences, minimally invasive surgery (also called keyhole surgery) is being practised. To reach the heart between the ribs, this advanced surgery involves making small incisions in the right side of your chest, instead of cutting through the breastbone, as is done in heart surgery. It leaves your breastbone intact, so you heal faster and recover faster. 

In general 8 to 10 sternotomy incisions are carried out during open-heart surgery. The minimally invasive surgery has only 3-4 incisions, in contrast to this. Medically supervised, technologically advanced robotic instruments are used in performing the surgery to project the dexterity of the surgeon's hands through these small incisions.

Why is Minimal Invasive Cardiac Surgery done?

 Heart surgery is a complicated procedure. Minimally invasive cardiac surgery ensures faster recovery and lower risk of procedure-related complications in patients. Minimally invasive heart surgery helps in carrying out many types of heart procedures like:

  • Heart valve repair or replacement

  • Maze procedure for atrial fibrillation

  • Coronary artery bypass surgery

  • Removal of Intracardiac  Tumor

  • Closure of Birth defect (ASD)

  • Aortic Root Surgery

 What are the Potential Benefits of Invasive Cardiac Surgery?

Minimally invasive cardiac surgery is associated with several benefits, when compared with open-heart surgery, namely:

  • Shorter ICU and Hospital Stay

  • The surgery involves less blood loss

  • There is a lower risk of infection

  • The trauma and pain are very much less than open-heart surgery. 

  • Patients recover faster and thus shorter hospital days. Hospital stays are about 3-5 days and compared to 5-7 days with open-heart surgeries.

  • Better Cosmetic outcome

Who gets Benefit from Invasive Cardiac Surgery?

A patient’s eligibility for minimally invasive cardiac surgery is determined by the doctor and the medical team. Before considering surgery, the physician performs a physical examination, reviews the patient’s medical history, and performs certain tests.

It should be remembered that every cardiac patient cannot be advised to undergo minimally invasive cardiac surgery. Hospitals that have physicians, surgeons, and medical teams, who are well trained, experts and have good experience to carry out such complex operations are generally involved in this surgery.

What you can expect?

During the procedure

  • There are three types of surgeries that are involved in minimally Invasive Cardiac Surgery

  1. robot-assisted heart surgery

  2. Thoracoscopic surgery

  3. A small incision is made in the chest for the surgery

  • To keep the blood moving through the body during the surgical procedure, a heart-lung bypass machine is used.

  • In robot-assisted heart surgery, the surgeon works with a robotic arm performing the surgery. The robotic "wrist" is attached to motion sensors, so the surgeon can control the instruments. The physician views your heart in a magnified high-definition 3D view on a video monitor. The surgical team involving the second surgeon helps in changing surgical instruments attached to the robotic arms.

  • In thoracoscopic surgery (also known as mini-thoracotomy) the surgeon inserts a long, thin tube called a thoracoscope. The tube contains a tiny high-definition video camera which helps in performing the incision and carrying out surgery.

After the Procedure

  • The patient has to stay in the ICU after the surgery. Intravenous (IV) lines will be used to supply fluids required by the body. Similarly, there will be other tubes which will drain urine from the bladder, and fluid and blood from the chest.

  • Oxygen will be supplied with the help of a facemask.

  • The patient will be moved to a regular ward once the body starts to recover.

  • The treatment team will:

  1. Monitor the condition and watch for signs of infection in the incision sites

  2. Monitor the blood pressure, breathing, and heart rate

  3. Carry out pain management procedures if any.

The patient should follow the physician’s instructions during the recovery period. 

Conclusion

Minimally Invasive Cardiac Surgery improves the patient’s quality of life. It reduces the symptoms. Physical activity, a healthy diet, management of stress, and not using cigarette or tobacco related products are some of the lifestyle changes which should be incorporated in a patient’s life. One can return to day to day activities, such as going to work, driving vehicles, and doing exercise after getting a good to go signal from a physician.

Regular follow-up appointments with the physician have to be done. The physician will monitor your improvement post-surgery.

The Cardiac rehabilitation program is recommended by physicians to patients who undergo cardiac surgery. It comprises exercises and physiotherapy that speed up recovery post-surgery.

 

Dr. Yugal Kishore Sharma

Chief Of Clinical Services, Head Of Cardiac Sciences And Chief Cardio Vascular Surgeon

Manipal Hospitals, Dwarka, Delhi

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