Minimally Invasive Cardiac Surgery
Rajeev Kathuria, MD, is a cardiothoracic surgeon and chief of cardiothoracic surgery at Banner Boswell Medical Center in Sun City.
Question: I keep hearing about minimally invasive surgery. What are the benefits with regard to heart valve replacement and how do I know if I’m a good candidate for this method?
Answer: Traditional open heart surgery requires what is known as a sternotomy, a procedure that entails cutting through the breastbone to access the heart. Though this method is still how the vast majority of heart surgeries are performed, advances in technology have given us new options and approaches that fall into the realm of minimally invasive surgery.
Generally speaking, there are many benefits to minimally invasive valve surgery. In the case of both aortic and mitral valve replacements, minimally invasive approaches enable surgeons to access the specific section of the heart they will operate on through a roughly two to three-inch incision between the ribs on the right side of the chest known as a minithoracotomy. Sometimes, small cameras are inserted into the chest to give surgeons a better view. This is particularly true for patients who are candidates for robotic surgery. Additionally, a small incision in the groin provides access to the femoral vessels in the leg so patients can be put on a heart/lung machine for the duration of the operation.
From smaller incisions, less pain and quicker recovery times to a decrease in the amount of blood products/transfusions needed after surgery and lower incidences of atrial fibrillation (a common arrhythmia of the heart following heart surgery), the benefits of minimally invasive heart surgery are many. However, there are circumstances and contraindications in which minimally invasive surgery isn’t an option or isn’t the best option.
Individuals of just about any age who need an isolated valve repair or replacement rather than those needing multiple heart procedures during the same surgery are the best candidates for minimally invasive valve surgery. But, like most things, there are exceptions. For instance, those who have had previous heart surgery may not be candidates for minimally invasive aortic valve replacement. However, they may still be able to undergo minimally invasive mitral valve repair or replacement. Another factor in determining whether someone qualifies for minimally invasive heart valve surgery is a history of lung surgery or other surgery on the right side of the chest since scar tissue often restricts access to the heart. Additionally, severe blockages in the arteries of the legs may disqualify someone from the minimally invasive approach since these blockages would hinder a patient from being able to be put on the heart/lung machine.
Ultimately, there are several approaches to valve repair and replacement surgery, each with their own prerequisites and qualifications. Talk to your doctor to find out whether your medical needs and history make minimally invasive valve surgery a viable option for you.