This term refers to a variety of techniques to perform bypass or valve surgery through smaller incisions. The hope and preliminary experience has been that these techniques allow for a quicker recovery with shorter, less expensive hospital stays. There seems to be less need for post-hospital rehabilitation and a quicker return to the patient's previous lifestyle. In addition there appears to be less postoperative pain, decreased need for transfusions and a lower risk of wound infections. The smaller incision also leads to a more acceptable cosmetic result.
Whereas standard open heart surgery involves a 20-25 centimeter incision through the length of the breastbone, minimally invasive techniques may use an incision through the breast bone that is much smaller. More commonly, a 6 centimeter incision is made horizontally either to the left or right of the breastbone-depending on the type of surgery being performed. Minimally invasive techniques can also be used to harvest the leg veins used to create bypasses. This results in much smaller scars in the legs as well.
Minimally invasive coronary artery bypass surgery is done on the beating heart. Cardiopulmonary bypass and the heart lung machine are not required. At the present time, this technique is not capable of bypassing all of the coronary vessels. It can only be used in patients with more limited blockages. Thus, this techniques may be more of a competitor to angioplasty techniques than to routine bypass surgery which is often done on patients with extensive blockages in all major coronary arteries.
Minimally invasive valve surgery does require that heart stop beating and use of cardiopulmonary bypass and the heart-lung machine. However, the hookups to the heart-lung machine are often done from blood vessels in the leg rather than the major blood vessels that enter and leave the heart. The heart beat can be stopped in the usual fashion by placing a clamp on the aorta to stop the blood flow through it. A different approach to stop the heart beat is used by the port access system. This technique uses a catheter that is placed through an artery in the leg and advanced into the aorta. A balloon at the tip is then expanded to block off flow through the aorta and stop the heart beat.
The latest advance is robotic surgery. This uses even smaller incisions and pencil thin instruments to perform the operation. The surgeon sits at a console with a video screen and guides robotic arms to operate the instruments.
Minimally invasive open heart surgery is a very new technique. Further experience is needed before we can determine with certainty whether or not this is better than standard open heart surgery techniques that have been giving good results for many years. These techniques are technically challenging to surgeons, most of whom have just learned them recently. It is probably in the patient's best interest to let the surgeon choose whatever technique he or she feels most comfortable with and that which is safest for the patient.
Related topics: Coronary Artery Bypass Surgery and Valve Surgery
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