Overview

Minimally invasive heart surgery involves making small incisions in the right side of the chest to reach the heart between the ribs, rather than cutting through the breastbone, as is done in open-heart surgery.

Minimally invasive heart surgery can be done to treat a variety of heart conditions. Compared with open-heart surgery, this type of surgery might mean less pain and a quicker recovery for many people.

Why it's done

Many types of heart procedures may be performed with minimally invasive heart surgery, including:

• Aortic valve replacement
• Atrial septal defect and patent foramen ovale closure
• Atrioventricular septal defect surgery
• Coronary artery bypass surgery
• Maze procedure for atrial fibrillation
• Mitral valve repair or replacement
• Saphenous vein harvest for coronary artery bypass surgery
• Tricuspid valve repair or replacement

The potential benefits of minimally invasive heart surgery when compared with open-heart surgery can include:

• Less blood loss
• Lower risk of infection
• Reduced trauma and pain
• Shorter time in the hospital, faster recovery and quicker return to normal activities
• Smaller, less noticeable scars

Minimally invasive heart surgery isn't right for everyone. Your doctor and treatment team will work with you to determine whether it's an option to treat your condition.

To determine whether minimally invasive heart surgery is the best option, your doctor will likely review your medical history and order tests to get more information about your heart health.

Minimally invasive heart surgery is a complex surgical procedure that requires training and experience. You might be referred to a medical center with surgeons and a surgical team who have the needed expertise in performing minimally invasive procedures.

Risks

Minimally invasive heart surgery can involve risks similar to open-heart surgery, such as:

• Bleeding
• Stroke
• Infection
• Irregular heart rhythms (arrhythmias)
• Death

Also, it's possible that minimally invasive heart surgery will need to be changed to open-heart surgery if your surgeon thinks it's not safe to continue with the minimal approach.

How you prepare

Before minimally invasive heart surgery, your doctor and treatment team will explain to you what to expect before, during and after the surgery and potential risks of the surgery.

Your doctor and team will discuss concerns you have about your surgery. Your doctor or another member of your treatment team might discuss with you advance directives or other information to consider prior to your surgery.

You may need to have your hair shaved at the areas of your body where the procedure will take place. Your skin might be washed with special soap to reduce the risk of infection.

Before being admitted to the hospital for your surgery, talk to your family about your hospital stay and discuss help you might need when you return home. Your doctor and treatment team will give you instructions to follow during your recovery when you return home.

Food and medications

Talk to your doctor about:

• When you can take your regular medications and whether you can take them before your surgery
• At what time you should stop eating or drinking the night before the surgery

Clothing and personal items

Your treatment team might recommend bringing several items to the hospital, including:

• A list of your medications
• Eyeglasses, hearing aids or dentures
• Personal care items, such as a brush, comb, shaving equipment and toothbrush
• Loose-fitting, comfortable clothing
• A copy of your advance directive
• Items that might help you relax, such as a portable music player or books

During surgery, avoid wearing:

• Jewelry
• Eyeglasses
• Contact lenses
• Dentures
• Nail polish

Precautions regarding medications and allergies

Talk to your doctor about:

• Medications you have brought to the hospital and when you should take medications on the day of the procedure
• Allergies or reactions you have had to medications

What you can expect

During the procedure

Minimally invasive heart surgery includes robot-assisted heart surgery, thoracoscopic surgery and surgery through a small incision in the chest (direct less invasive access heart surgery). In all types, surgeons reach your heart through small incisions between the ribs of your chest.

A tool with a small video camera inserted through one of the incisions is used to help the surgeon see inside your body.

Most minimally invasive procedures use a heart-lung bypass machine, as is used in open-heart surgery. The machine keeps blood moving through your body during the procedure.

Robot-assisted heart surgery

In robot-assisted heart surgery, the surgeon uses robotic arms, rather than his or her hands, to perform the exact maneuvers used in traditional open-heart surgery.

During this procedure, your surgeon works at a remote console and views your heart in a magnified high-definition 3D view on a video monitor. From the console, your surgeon's hand movements translate precisely to the robotic arms at the operating table, which move similarly to the human wrist.

A second surgeon and surgical team assist at the operating table, changing surgical instruments attached to the robotic arms.

Thoracoscopic surgery

In thoracoscopic surgery (sometimes referred to as a minithoracotomy), your surgeon inserts a long, thin tube (thoracoscope) containing a tiny video camera into a small incision in your chest.

Your surgeon repairs your heart using long instruments inserted through small incisions between your ribs.

After the procedure

You'll generally spend a day or so in the intensive care unit (ICU). You'll be given fluids and medications through intravenous (IV) lines. Other tubes placed during surgery will drain urine from your bladder and fluid and blood from your chest. You might be given oxygen through a face mask or prongs in your nose.

After the ICU, you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital will depend on your condition and surgery.

Your treatment team will:

• Monitor your condition and watch for signs of infection in your incision sites
• Monitor your blood pressure, breathing and heart rate
• Work with you to manage pain
• Get you up and walking and instruct you to gradually increase your activity
• Show you how to do deep-breathing exercises and instruct you to cough to keep your lungs clear

Your doctor will give you instructions to follow during your recovery, such as watching for signs of infection, caring for your incisions, taking medications and managing pain.

Your doctor will tell you when you can return to daily activities, such as working, driving and exercise.

Results

Minimally invasive heart surgery may help reduce aortic stenosis symptoms and improve your quality of life.

You'll usually need regular checkups with a doctor to monitor your heart condition. Tests may be done to check your heart health.

Your doctor may also recommend following a heart-healthy lifestyle, which includes eating a healthy diet, exercising, managing stress and avoiding tobacco use. Sometimes, a personalized program of education and exercise designed to improve health after heart surgery (cardiac rehabilitation) is also recommended.