Minimally Invasive Heart Surgery

The two types of minimally invasive heart surgery are robot-assisted heart surgery and thoracoscopic surgery.

• Robot-Assisted Heart Surgery: With this method, surgeons use a computer to control small robotic arms inserted through small incisions to perform heart surgery while watching a high-definition video of the heart and the inside of the patient's chest. Robotic-assisted heart surgery enables surgeons to perform precise and controlled movements during complex operations.

• Thoracoscopic Surgery (also called mini-thoracotomy): In this minimally invasive heart surgery procedure, surgeons insert a thoracoscope—a long, thin and flexible tube equipped with a small video camera and small surgical tools through a small incision between the ribs to examine and repair the heart. In some cases, surgeons perform thoracoscopic surgery as part of video-assisted thoracic surgery (VATS). Surgeons commonly perform thoracoscopic surgery to treat heart lesions (such as coronary artery disease and valve problems), lung cancer, chest trauma, esophageal cancer, emphysema and heart and lung transplantation.

Minimally invasive heart surgery can be used in various procedures, including:

• Minimally invasive heart bypass surgery or coronary artery bypass graft surgery (CABG): A medical procedure that involves using healthy blood vessels from another part of the body, usually from the arm or chest or veins from the legs and connecting them to blood vessels above and below a blocked artery. This new blood vessel is called a graft. Minimally invasive heart bypass surgery creates a new pathway for oxygen-rich blood to flow around or "bypass" the narrowed or blocked coronary arteries.

• Minimally invasive heart valve surgery: Surgeons perform minimally invasive heart valve surgery to repair or replace diseased valves. Surgeons repair the ring-like part around the valve by sewing a ring of plastic, cloth or tissue around it or trimming, shaping or rebuilding one or more leaflets (flaps that open and close the valve). If the valve is too damaged, valve replacement surgery will be necessary. During this procedure, the surgeon will replace the damaged valve with either a mechanical (made from metal or ceramic) or a biological (made from human or animal tissue) valve. The mitral valve is the most commonly replaced, while the aortic valve is usually replaced rather than repaired. The tricuspid and pulmonic valves are rarely repaired or replaced.

• Maze procedure: This surgery involves making small incisions in the upper heart stitched together to form scar tissue. This scar tissue disrupts the electrical signals that cause atrial fibrillation, helping to restore a normal heartbeat.

• Pacemaker or implantable cardioverter-defibrillator (ICD) insertion: Defibrillators and pacemakers help manage heart rhythms. Defibrillators restore a normal heartbeat by sending an electric pulse or shock to the heart, preventing or correcting arrhythmias and restarting the heart if it stops due to ventricular fibrillation. Pacemakers send electrical pulses to maintain a normal heart rate and rhythm and synchronize heart chambers for efficient blood pumping. Pacemakers can be temporary or permanent, with permanent ones consisting of a small battery implanted under the skin and leads connecting to the heart muscles.

• Ventricular-assist device (VAD) placement: A ventricular-assist device is a mechanical pump that aids the heart in pumping blood when it cannot efficiently do so. This device can support the heart's lower chambers, the left, right, or both ventricles. A VAD consists of tubes to transport blood, a power source and a control unit to monitor its function. Ventricular-assist devices can be used to help the heart recover, support the heart while awaiting a heart transplant or improve heart function for patients not eligible for a heart transplant.

Candidates for minimally invasive heart surgery usually include individuals who need specific heart procedures but are at higher risk for complications from traditional open-heart surgery. Many patients qualify for a minimally invasive heart surgery approach. People with severe aortic stenosis or mitral regurgitation are some of those who may benefit from less invasive heart surgery. To determine if you are a suitable candidate for minimally invasive heart surgery, consult a cardiovascular surgeon experienced in these techniques. Together, we can help decide your best possible treatment plan.

Minimally invasive heart surgery, such as coronary artery bypass graft surgery, usually takes three to six hours. However, the procedure may take longer depending on the number of arteries that need to be bypassed.