Is Small-Incision Heart Surgery Possible for You?

3 alternatives to open heart surgery

Is Small-Incision Heart Surgery Possible for You?

When you hear that you need heart surgery, you may see a picture in your head of a surgeon performing open-heart surgery. However, we now perform many heart surgeries with a minimally invasive or small-incision approach.

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The benefits of these less invasive surgeries are less bleeding, less trauma, fewer infections and a quicker recovery.

In minimally invasive surgery, we make smaller incisions (sometimes as small as a keyhole) with or without the use of robotics. This approach works best for three types of heart surgeries.

1. Heart valve operations

A valve operation is the most common minimally invasive procedure for a heart surgery — either a valve repair or a valve replacement. We perform these through small incisions made from a special surgical tool in the side of the chest, a small incision over the breastbone or sometimes even with robotic assistance.

Traditional heart surgery requires a large incision (typically 6 to 8 inches in length) over the middle of the breastbone (sternum), but more recent advances reduce incisions to 2 to 4 inches in length. Not only does this reduce pain and blood loss, but it leaves less scarring. And you likely will have a shorter hospital stay.

Through robotically assisted valve surgery, we now use a specially designed computer console to control surgical tools on thin robotic arms.

The robotic arms gently ease into a 1- to 2-inch incision in the right side of your chest. The surgeon’s hands then control the endoscopic tools to open the pericardium (the thin sac around the heart) to perform the surgery.

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2. Coronary artery bypass grafting

We also perform coronary artery bypass grafting (CABG) with a small-incision approach, either through the center of the chest or through the side.

We tend to reserve this procedure for patients who need one or two bypass grafts. Through a CABG, we bypass one or more blocked coronary arteries with a blood vessel graft to restore normal blood flow to the heart.

These grafts usually come from the patient’s own arteries and veins located in the chest, leg or arm.

The graft goes around the blocked arteries to create new pathways for oxygen-rich blood to flow to your heart. The goals of the surgery are to relieve symptoms of coronary artery disease, allow you to return to a normal lifestyle and lower your risk of a heart attack or other heart problems.

3. Aortic procedures

We perform some aortic procedures, such as a Type B dissection, through small incisions, as well.

If you have high blood pressure or a disease that affects the connective tissues of your body, the aortic artery sometimes develops a dissection (or a tear) in its arterial lining. Your blood normally flows through the aortic artery like water inside a garden hose. When a tear occurs, your blood seeps through the lining of your artery.

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With a Type B dissection, a tear occurs in the part of the aortic artery that runs through your chest and abdomen into the organs and lower extremities. In the past, we could only repair it through open surgery.

Now, we fix it via a minimally invasive approach by using a stent. We insert a tiny tube through the groin into the aortic artery and expand it to seal off the tear — and keep the torn part of the artery open.

Choosing the best approach

In choosing the best approach, it’s important for you to find a heart surgeon with experience in all approaches. The two of you then can work together to decide how best to fix your problem.

Be sure your surgeon knows that you want to explore a minimally invasive option. Ask how frequently he or she does the surgery, so you can get an idea of how comfortable and experienced the surgeon is.

If your surgeon has little experience with small-incision approaches, you may want to seek another opinion or get a new referral.

Contributor: Stephanie Mick, MD

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