Minimally Invasive Cardiac Surgery – Heart is one of the most important parts of the body. There is a huge amount of effort required to maintain the functioning of the heart. One of the latest trends in the industry for a healthy heart is minimal invasive heart surgery. The surgery is safe and does not have any major side effects. Let us move on and understand the surgery in a quick detail.
Over many decades cardiac surgery is done through larger midline incision by cutting breast bone (sternum). Although the exposure and ease of surgery was excellent with this approach but with advancements in technology and instruments now it’s the time for EVOLUTION.
In Minimal Invasive Heart Surgery, surgeon doesn’t cut the breastbone (sternum) rather he operates between ribs by using special instruments. For surgeries of heart valve and congenital defects, bypass machine is attached using small (2 cm) groin incision and heart surgery is performed through another 5 cm incision on right side of chest. There are various options for minimal invasive heart surgeries:-
MICS for heart hole patients and valve disease patients: Small cut is given on right side of chest usually below right breast. No bone is cut and after recovery, it’s difficult to visualize the scar from front.
MIDCAB (Minimally Invasive Direct Coronary Artery Bypass) is small incision approach of performing surgery for coronary artery disease. Surgeon harvests mammary artery from chest wall using harmonic instrument or long shaft cautery and special retractors. This harvested artery is then stitched to coronary arteries.
Also See: Heart Specialist in Chandigarh
Hybrid MIDCAB is newer approach used to completely revascularize in coronary disease using both mammary artery and stents. Mammary artery is most important graft with life of over 20 years in good target vessels. So revascularization of left anterior descending artery with mammary artery and using stents for non-LAD targets achieves bests of both techniques.
TECAB (Totally endoscopic coronary artery bypass) is performed using robotic surgical system. After single lung ventilation and CO2 insufflation inside chest cavity, mammary artery is harvested using robotic arms. Heart is stabilized with special endoscopic instruments and anastomosis to coronary arteries is done.
Minimally invasive cardiac surgery has been proven to have outcomes similar to the conventional open heart surgery but many advantages can be achieved with this approach.
Due to smaller incision and less blood loss, patients recover faster and return to their work earlier. They generally spend less than 24hrs in recovery area, are mobilized faster and so can be discharged earlier from the hospital. Just within 2-3 weeks these patients can start driving and can even lift mild- moderate weights.
Worldwide more and more centers are adopting minimally invasive approach as standard for majority of their heart surgeries. Initial programs were started with less complex diseases like ASD and single valve replacements. With gain in experience and advancements of technology more complex cases such as double valve replacements, complex congenital cases and even multivessel bypass is now possible with this approach.
Patient factors such as very bad lungs (single lung ventilation difficult), badly diseased abdominal aorta (femoral cannulation impossible) and co-existing medical issues are relative contraindications for the minimal invasive approach.
Minimally invasive approach will continue to grow and evolve with advancements in technologies and gain in experience of surgeons across the world. Patient’s with believe in reduced surgical stress of MICS approaches; will choose more durable surgical options. In future patients are more likely to ask for MICS approaches for their cardiac problems due to obvious potential benefits of early return to normal activities and improved quality of life. Many centres will come up with hybrid operating rooms and heart teams will work together for best outcomes.
Also See: Bypass Heart Surgeon in Chandigarh