Definition & Overview

There are two methods used to perform heart surgery these days. The first one is called open-heart surgery. This is the traditional method in which the surgeon makes a long vertical incision in the chest. He or she also has to separate the ribs to access the heart. The second is minimally invasive surgery (MIS). It uses small incisions. Tiny, specialised surgical instruments are inserted into the incisions.

Many surgeons prefer the second method because it is less risky. Because the incisions are very small, MIS reduces the many risks of surgery. These include pain and scarring as well as infection and excessive bleeding.

But it is important to note that there are cases in which MIS is not applicable. An example is a heart transplant. This procedure requires a bigger incision in order to remove and replace the diseased heart.

Who Should Undergo & Expected Results

The following can be performed using MIS:

  • Repair or replacement of heart valves - This surgery is done when any of the valves has narrowed or hardened. When valves are narrowed, the amount of blood that flows through them is reduced. If they are blocked, on the other hand, the blood supply to vital organs may be cut off. Regurgitated valves are also treated. Regurgitated means that the valve allows the blood to flow back to the heart.

  • Repair of holes in the heart - Some people have a hole in between the two chambers of their heart. In others, the hole is in between their left and right atria. Both conditions affect the flow of blood in the heart. Both are treated by closing the hole using a patch.

  • Coronary artery bypass surgery (CABG) - This surgery is used in patients with a clogged artery. It is done to restore normal blood flow to the heart muscle. It uses a grafted healthy vein from another part of the body. The vein is then connected to the blocked artery. This gives the blood another route to get to the heart muscle. This reduces the risk of heart failure and heart attack.

  • Maze procedure for atrial fibrillation - This is done to create scar tissue that can block abnormal electrical signals that cause arrhythmia.

As for the expected results, the patient’s quality of life should significantly improve. Their risk of developing more serious heart problems, such as a heart attack, is reduced.

How Does the Procedure Work?

Before the procedure, the patient undergoes blood and urine tests as well as a chest x-ray. This gives the surgeon the latest status of their heart and health. They are then connected to an ECG monitor. They are also given anaesthesia so they will not feel any pain. This will make them fall and stay asleep during surgery.

The patient is also connected to a number of tubes. One is connected to a respirator that helps the patient with his or her breathing. Another one is used to prevent air and liquid from collecting in the stomach. This helps ensure that the patient does not wake up feeling sick and bloated. A thin tube is also inserted into the bladder. This collects the urine during the operation.

The surgeon will start by making a number of small incisions in the chest. He or she can use a thoracoscope (thoracoscopic surgery). This is a long tube with a built-in camera. The camera takes images of the surgical area. The images are then projected onto monitors in the operating room. They provide surgeons a magnified view of the heart. Special, tiny surgical tools are inserted into the other incisions so surgeons can make necessary repairs.

The surgeon can also use robotic arms (robot-assisted heart surgery). He or she will control the robotic arms using a computer console. The main benefit of this method is it allows surgeons to perform surgery with more precision and control.

A catheter can also be used in replacing the aortic valve. For this, the surgeon will insert a catheter into the large artery in the groin or chest to deliver the replacement valve.

After surgery, the patient is:

  • Connected to a machine that monitors his or her heart function.

  • Given medications, nutrition, and fluid via intravenous lines.

  • Given oxygen to help them breathe properly.

  • Transferred to the intensive care unit (ICU) where they’ll receive the level of care they need.

  • Monitored for complications, such as bleeding and infection.

  • Given medications for pain relief.

Possible Complications and Risks

MIS is not without risks. Complications can also occur. These include:

  • Blood clot formation. Blood clots can form and travel to the lungs. They can obstruct or totally cut off blood supply to vital organs.

  • Severe bleeding

  • Breathing problems

  • Heart attack or stroke

  • Infection

  • Heart rhythm problems

  • Chest pain

References:

  • What is heart surgery? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hs.

  • Barbara Woodward Lips Patient Education Center. Minimally invasive heart surgery. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2012.

  • Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(23):e652-e735. PMID: 22064599.

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