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Minimally Invasive Heart Surgery

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Minimally invasive heart surgery is when a surgical procedure is performed on or inside the heart using small incisions rather than the large incisions required with traditional open heart surgery.  Also, cardiothoracic surgeons sometime use specialized instruments including endovascular catheters and robotically-assisted surgical tools.

The benefits of minimally invasive surgical techniques include: 

  • Small incisions
  • Smaller post-surgical scars
  • Less postoperative surgical pain
  • Shorter length of hospital stays after surgery
  • Lower risk of infection
  • Lower risk of bleeding and need for blood transfusions

Cardiothoracic surgeons in the Einstein Healthcare Network strongly believe in the minimally invasive approach to heart surgery.  In fact, every patient is considered for minimally invasive cardiothoracic surgery, but not everyone is a candidate.

Some of the factors that determine whether an individual is a candidate for minimally invasive cardiothoracic surgery include: 

  • Type and severity of heart disease
  • Age
  • Medical history and personal health
  • Lifestyle considerations
  • Pre-surgical laboratory tests and results

Sometimes a hybrid approach, using a combination of interventional cardiology and minimally invasive surgery may be appropriate for some heart patients.

The success of the minimally invasive cardiothoracic surgical programs at Einstein is rooted in a multidisciplinary team approach to cardiac patient treatment and care. These teams typically consist of cardiac surgeons, cardiologists, attending physicians' nurses, physical/occupational therapists, medical support personal and others. Together, team members' works to reduce the length of hospital stays and ensure speedy recovery for cardiothoracic surgical patients.

Types of Minimally Invasive Heart Surgery

MINIMALLY INVASIVE HEART VALVE REPAIR OR REPLACEMENT

Faulty or damaged heart valves must be surgically repaired or replaced to ensure normal cardiac function and health. Minimally invasive surgery uses smaller incisions, and in some cases endovascular catheters (inserted via blood vessels in the groin) to repair/replace damaged or faulty heart valves.

During valve repair surgery, cardiovascular surgeons fix damaged or faulty heart valves in an effort to maintain and restore the natural anatomy. Valve replacement surgery is performed when valve repair is not a treatment option.

Valve replacement surgery involves removal of the faulty valve and replacing it with a biological or a mechanical valve. All valve replacements are biocompatible which means that the new valve will not be rejected by the body's immune system.

Biologic valves are made from human, cow or pig tissue and can last from 15-20 years without loss of function. Mechanical valves, which require anticoagulation, are made of metal or carbon-based polymers and designed to work like normal cardiac valves. Mechanical valves are durable, well tolerated by the body and designed for lifelong use without replacement.

ATRIAL SEPTAL DEFECT REPAIR

An atrial septal defect is a hole in the wall between the upper left and right chambers (atria) of the heart. They are frequently described as heart murmurs. Atrial septal defects can go undetected until adulthood and adults with these defects often may experience other cardiac problems.

If the hole is large, oxygen-rich blood from the left atrium flows back into the right atrium and blood gets pumped back to the lungs which causes the heart to work harder and may result in serious cardiac problems. Smaller atrial septal holes are sometimes associated with stroke or transient ischemic attacks (TIAs or "mini strokes"). Small holes resolve over time on their own whereas larger holes generally require surgical intervention.

Repair of septal defects using minimally invasive surgery employs endovascular catheters (inserted via blood vessels in the groin) to patch the defect. In some cases, robotically-assisted or minimally invasive surgery may also be used to repair atrial septal defects.

In atrial septal repair surgery, a small piece of pericardial tissue (the pericardium is the thin sac that surrounds the heart) is surgically removed and used to patch the hole between the right and left atria.

MAZE SURGERY FOR ATRIAL FIBRILLATION

Atrial fibrillation of the heart, sometimes called afib, is an abnormal, irregular and often rapid heart rhythm caused by improper atrial cardiac electrical impulses. It can be associated with a high risk for stroke and eventual weakening of the heart muscle. The most common treatment for afib is percutaneous ablation by an electrophysiologist, but can require MAZE.

MAZE is a surgical ablation procedure that can be used to correct atrial fibrillation. It involves creating multiple lesions with different forms of energy (freezing or heating) arranged in a maze-like pattern in the atria of the heart to force electrical impulses that stimulate heartbeat to ventricles to restore normal heart rhythms.

MAZE can be performed in conjunction with other open heart surgeries if necessary. However, MAZE surgeries can be performed as standalone, minimally invasive procedures using small incisions and specialized instruments. Because minimally invasive surgery involves smaller incisions, it allows patients to heal faster, shortens hospital stays, reduces the likelihood of infection and allows people to return to normal activity sooner.

CORONARY ARTERY BYPASS GRAFTING (CABG)

Coronary artery bypass grafting (CABG) is a type of revascularization surgery that is used to improve blood flow to the heart in people with severe coronary artery disease or worsening chronic heart failure. During CABG, cardiovascular surgeons create a 'bypass" around obstructions or blockages in affected coronary arteries by performing grafts with veins or arteries from the chest, leg or arm. The graft goes around the clogged or blocked arteries, restores the normal flow of oxygen-rich (red) blood to the heart muscle and improves cardiac function

Traditional CABG requires an incision down the middle of the chest and opening of the sternum to access the heart. In contrast, minimally invasive CABG uses small incisions and can be performed with robotic assistance. This allows patients to heal faster, shortens hospital stays, reduces the likelihood of infection and allows them to return to normal activity sooner as compared with traditional CABG surgery.

ROBOTICALLY-ASSISTED CABG

Robotically assisted coronary artery bypass (CABG) surgery is a type of minimally invasive heart surgery performed by cardiothoracic surgeons. In this procedure cardiovascular surgeons use robotic surgical devices to perform certain parts of the procedure. Because robotically-assisted CABG is minimally invasive it requires smaller incisions which allows patients to heal faster, shortens hospital stays, reduces the likelihood of infection and allows them to return to normal activity sooner as compared with traditional CABG surgery.

In the hybrid robotically-assisted procedure, the robotically-assisted surgical procedures are used in combination with coronary artery stenting to perform minimally invasive CABG surgery.

MINIMALLY INVASIVE AORTIC ANEURYSM RESECTION/REPLACEMENT

Endovascular aortic aneurysm surgery is a minimally invasive procedure that uses long thin catheters inserted inside of the aorta (via blood vessels in the groin) that guide and deliver stent grafts to the site of the aneurysm. Deployment of the stent graft in the diseased segment of the aorta relines the aorta like a sleeve restores integrity to the aortic wall and diverts blood flow away from the aneurysm.

Minimally invasive endovascular stent grafts can be used to treat thoracic, abdominal and thoracoabdominal aortic aneurysms. Endovascular repair of aortic aneurysms is generally less painful and lowers the risk of complications associated with traditional open surgeries because the incisions are smaller. Patients who undergo endovascular aortic aneurysm surgery generally leave the hospital earlier and recover more quickly than patients undergoing traditional open heart procedures.

MINIMALLY INVASIVE TRANSCATHETER VALVE REPLACEMENT (TAVR)

Transcatheter aortic valve replacement (TAVR) is a surgical treatment option for some patients with severe aortic stenosis who are too ill to have traditional, open-heart surgery to replace the aortic valve.

During TAVR cardiovascular surgeons use a catheter to replace the diseased aortic valve with a prosthetic/biologic valve.  The catheter is inserted into an artery in the groin or an incision in the chest.

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