Minimally invasive cardiac surgery is defined in two different ways. It can refer to a surgery that doesn't require a full sternotomy, or breaking of the breastbone, and that usually involves access to the heart between two ribs, instead. Minimally invasive may also mean heart surgery without cardiopulmonary bypass. In this second definition, a person with a sternotomy could still have a minimally invasive surgery if bypass is not used. The first definition is used more often than the second and will be the focus of this article.
There’s been a general movement toward developing a number of minimally invasive cardiac surgery techniques that can be adapted for a wide variety of surgeries. A surgeon can access many parts of the heart for repairs on the valves, for bypass surgery or to close congenital defects like atrial septal defects or patent foramen ovale. The advantages of this form of surgery tend to be that there is far less postoperative pain and minor less visible scarring. Minimally invasive techniques have been shown to be as safe and effective as standard methods that involve access through the sternum, though no heart surgery is without risk.
Not all heart repairs can be done with access through the ribs. This type of surgery may not be appropriate for people who have had previous heart surgeries. Alternately, the repair may be so significant that greater access to the heart is needed. Similarly, heart repair without using cardiopulmonary bypass is not always possible, though warm, beating heart surgeries can be performed for complex procedures like the Fontan.
Another emerging definition for minimally invasive cardiac surgery involves the use of robotics. For a few surgeries, and if surgeons have the appropriate equipment, a robot controlled by a surgeon can make tiny incisions and precise repairs to the heart. This technology is still new and it isn’t offered by every hospital.
As previously mentioned, there can be real advantage to a minimally invasive cardiac surgery. The reduction in postoperative pain can be significant because it corresponds to shorter hospital stays, and patients might run less risk of getting opportunistic infections if they are at home. On the other hand, the risk of complications from a procedure are often highest in the first few days after surgery, and going home too soon might risk experiencing complications at home.
Given the potential benefits, it can be worth discussing with a surgeon whether minimally invasive cardiac surgery is an appropriate choice. Not all surgeons favor this method and not all are trained to offer extensive surgery choices with this option. Those considering a cardiac surgery can certainly find surgeons that are skilled, but even then, not all types of patients or cardiac problems are best treated with this method.
