Minimally Invasive Heart Surgery
MINIMALLY INVASIVE HEART SURGERY
INTRODUCTION OF MINIMALLY INVASIVE HEART SURGERY
Most cardiac operations today are performed through a sternotomy, which involves splitting the entire breastbone. Minimally invasive cardiac surgery encompasses a variety of operations performed through incisions that are substantially smaller and less traumatic than the standard sternotomy. Minimally invasive incisions measure about 3 to 4 inches compared to 8 to 10 sternotomy incisions. Specialized handheld and robotic instruments are used to project the dexterity of the surgeon’s hands through these small incisions in performing the operations.
INDICATION OF MINIMALLY INVASIVE HEART SURGERY
Surgical Ablation System is intended for minimally invasive cardiac surgical procedures, including the treatment of cardiac arrhythmias. The Cardioblate CryoFlex 7cm, 10cm, and 10-S probes plus the Cardioblate CryoFlex Clamp and Cardioblate CryoFlex Surgical Ablation Console freeze target tissue and block the electrical conduction pathways by creating an inflammatory response and cryonecrosis.
TYPES OF MINIMALLY INVASIVE HEART SURGERY
Mayo Clinic heart surgeons work with an experienced surgical team to perform minimally invasive heart surgery, including robot-assisted heart surgery and thoracoscopic heart surgery. In both types of procedures, surgeons reach your heart through small incisions between the ribs of your chest.
Robot-assisted heart surgery.
In robot-assisted heart surgery, the exact maneuvers performed in traditional open chest operation are duplicated by the surgeon using robotic arms, rather than his or her hands. During this procedure, your surgeon works at a remote console and views your heart in a magnified high-definition 3-D view on a video monitor.From the remote console, your surgeon’s hand movements are translated precisely to the robotic arms at the operating table, which move similarly to the human wrist. A second surgeon and surgical team assists at the operating table, changing surgical instruments attached to the robotic arms.
In thoracoscopic surgery (sometimes referred to as a mini-thoracotomy), your surgeon inserts a long, thin tube (thoracoscope) containing a tiny high-definition video camera into a small incision in your chest. Your surgeon repairs your heart using long instruments inserted through small incisions between your ribs.After performing a physical examination and reviewing your clinical records, echocardiogram, and CT scan, Mayo Clinic doctors will determine whether a conventional open operation or minimally invasive operation is best for you.
ANESTHESIA OF MINIMALLY INVASIVE HEART SURGERY
Minimally invasive cardiac surgery refers to a series of surgical techniques characterized by either a limited surgical access or by a reduced operative intervention. In the last years, cardiac surgery and consequently cardiac anesthesiology have been involved with new surgical procedures and different technical approaches that have significantly changed the perioperative management of cardiac surgery patients. These procedures that shorten the length of surgery and the perioperative stress have been expanding in all surgical fields as in cardiac surgery. By limiting the surgical wounds and intraoperative stress, often avoiding cardiopulmonary bypass, the minimally invasive cardiac surgery techniques provide a more rapid patient recovery, reduce hospital length of stay, and generally improve the postoperative outcome [1–3].
PREOPERATIVE PROCEDURE OF MINIMALLY INVASIVE HEART SURGERY
- Tell your doctor what medications you’re taking, especially aspirin or an anticoagulant, sometimes called a “blood thinner.” Ask if you should stop taking them.
- If you smoke, stop now to improve your blood flow and breathing.
- Don’t eat or drink anything after midnight the night before surgery.
- The anesthesiologist is the doctor who gives you anesthesia. It keeps you asleep and free of pain during surgery. He or she will talk to you about this before your surgery.
- Any hair in an incision area may be removed. You may also be asked to wash with an antibacterial soap the morning of surgery.
- If you are having valve surgery and need dental work, you may be told to have it done before surgery. This is because dental work can let bacteria enter the bloodstream, which may cause infection around a new valve.
PROCEDURE OF MINIMALLY INVASIVE HEART SURGERY
MICS CABG is performed through one 5–7 cm incision in the 4th intercostal space (ICS). In some cases the thoractomy may be necessary in the 5th ICS instead. A soft tissue refractor is used to allow for greater visibility and access.
Two access incisions are also made at the 6th intercostal space and xphoid process to allow for instruments to position and stabilize the heart.
The McGinn Technique (Proximal Anastomoses)
The McGinn Proximal Technique is performed with the blood pressure lowered to 90-100 systolic which reduces stress to the aorta. A series of tools are used to position and stabilize vessels. The technique uses devices to support the surrounding heart tissues while vital surgery takes place. This is also known as Off-Pump CABG (OPCAB). OPCAB voids the use of Cardiopulmonary Bypass (CPB), which requires the heart to be stopped (arrested) with cardioplegia solution. Off-pump is also known as beating heart surgery.
Minimally invasive heart surgery has been used as an alternative to traditional surgery for the following procedures:
- Coronary artery bypass
- Mitral valve repair
- Mitral valve replacement
- Aortic valve replacement
- Atrial septal defects
- Hybrid coronary revascularization
POSTOPERATIVE PROCEDURE OF MINIMALLY INVASIVE HEART SURGERY
After a minimally invasive procedure, patients recover more quickly than from sternotomy and suffer fewer complications. Most patients can expect to resume everyday activities within a few weeks of their operation. After surgery, patients are administered an anaesthetic pain pump and drains that will be removed prior to discharge. Patients are encouraged to move around as much as possible after their operation to recover quickly. Once discharged from hospital, patients require no further post-operative assistance.
Minimally invasive heart surgery is a safe and broadly applicable technique for performing a wide range of complex heart procedures, including single or multiple heart valve procedures, bypass surgery, and congenital heart repairs.
COMPLICATIONS OF MINIMALLY INVASIVE HEART SURGERY
Ask your doctor 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 for any surgery include:
- Blood clots in the legs that may travel to the lungs
- Blood loss
- Breathing problems
- Heart attack or stroke
- Infection of the lungs, urinary tract, and chest
Possible risks of coronary artery bypass include:
- Memory loss, loss of mental clarity, or “fuzzy thinking” – less common in people who have minimally invasive coronary artery bypass than in people who have open coronary bypass
- Heart rhythm problems (arrhythmia)
- A chest wound infection – this is more likely to happen if you are obese, have diabetes, or have had coronary bypass surgery in the past
- Low-grade fever and chest pain (together called postpericardiotomy syndrome), which can last up to 6 months
- Pain at the site of the cut