Minimally invasive heart procedures a boon for patients

Today there is the marvel of "minimally invasive heart surgery."

If you think about it, conventional heart surgery can seem cruel. Consider, in order to correct a problem deep in the heart, surgeons have to crack open the chest and then cut through bones and muscle before they can operate. The heart itself needs to be stopped, leaving patients in what can best be imagined as a sort of suspended state, neither dead nor alive, while the surgeon performs the surgery on the heart itself. The long and painful recovery that follows, while much shorter today than surgery performed in the 1960s, largely stems from the side effects and not the surgeon's work on the heart itself.

Minimally invasive or keyhole surgery is far less traumatic than conventional surgery. Since it was first used for gall bladder surgery in the late 1980's the techniques of minimally invasive surgery have changed the standards for how many operations are done.

Minimally invasive heart surgery is performed through a small incision about two to four inches long and uses surgical instruments designed just for the particular type of procedure being performed. This is surgery that avoids cracking the sternum and slicing though bones and muscle in order to operate on a heart in trouble, but rather enters the chest cavity through seemingly impossible small incisions and achieves the same results without all the trauma of the conventional surgery. In addition, the heart never stops beating, a heart-lung machine is not needed, recovery time is shortened by about half, the hospital stay is shortened and patient costs are reduced.

Patients who have minimally invasive heart surgery instead of conventional open-heart surgery have a lower risk of complications associated with the heart-lung machine such as stroke, lung problems, kidney problems and problems with mental clarity and memory. In addition to reduced complications, other benefits include a smaller incision, a smaller scar, reduced risk of infection, less bleeding, less pain and trauma and faster recovery and reduced .hospital costs.

The average hospital stay is three to five days after minimally invasive surgery, while the average stay after conventional heart surgery is five days. The average recovery time after minimally invasive heart surgery is two to four weeks, while the average recovery time after conventional heart surgery is six to .eight weeks.

Gino J. Sedillo, M.D., F.A.C.C. is an Interventional Cardiologist who is associated with the Bradenton Cardiology Center in Bradenton. Dr Sedillo completed his residency in Internal Medicine at the University of Texas and went on to the Texas Heart Institute, St. Luke's Hospital, Houston, Texas where he completed his .cardiology training. He .also is currently Medical Director of the Cardiac Catheterization Laboratories at Manatee Memorial Hospital.

"Blockage of the arteries is the number one reason for open-heart surgery," said Dr. Sedillo. "The number of open-heart surgeries has been declining over the past years." Instead of conventional open-heart procedures, surgeons are now using, when appropriate, minimally invasive heart surgery techniques in which a catheter with a balloon is run through a vein from the groin and into the heart. The balloon is then inflated and once the artery is open it is withdrawn and a coronary stent is left behind to hold the artery open. "The newer stents," said Dr. Sedillo, "hold the artery open much longer than the older ones did."

Dr. Sedillo pointed out that in addition to blocked arteries, primary use of the new technology is for patients with heart valve problems. "When a valve has narrowed we can use a volvuaplasty balloon to open the valve. We get better blood flow through valve." Frequently such a procedure is the only option for a patient who is too high risk for conventional surgery.

The mitral valve is the most commonly repaired valve, but the aortic, pulmonic and tricuspid valves may also undergo similar repair techniques, or even replacement.

What is it that enabled the introduction of minimally invasive heart surgery? Dr. Sedillo said it was the development of better technology, better equipment, and instruments designed to fit the small openings."

Dr. Sedillo cautioned that not all patients are right for minimally invasive surgery. "The anatomy of the patient has to be right for it." Despite what you hear, minimally invasive doesn't always mean better

For a surgeon there are three goals to every operation: to fix the problem, to do it safely, and to do it with the least trauma possible. If any of these goals were to be sacrificed, it would be the third in order to achieve the first two.

The various types of heart surgeries performed today are often referred to by their initials, including CABG, which is the conventional open-heart surgery procedure, and MIDCAB, OPCAR and PACAB, all considered minimally invasive procedures.

During a conventional Coronary Artery Bypass Graft (CABG) blood flow is rerouted through a new artery or vein that is grafted around diseased sections of coronary arteries to increase blood flow to the heart muscle tissue. This bypass typically requires open-chest surgery and the use of a heart-lung bypass machine to circulate the blood and add .oxygen.

Known as "MIDCAB" surgery, the Minimally Invasive Direct Coronary Bypass procedure is for patients with blockage or blockages in the arteries on the front of the heart. It allows the surgeon to perform bypass surgery without splitting the breastbone. A cut is made on the patient's left chest to expose the heart, but, unlike conventional open-heart surgery, it is much smaller. A heart-lung machine is .not required.

For an Off-Pump Coronary Artery Bypass, known as "OPCAB," the surgeon must open the chest and split the breastbone. A heart-lung machine however is not used. An artery or vein is taken from the patient's leg and used to make the bypass. Compared with patients undergoing conventional heart bypass surgery, OPCAB patients require fewer blood transfusions, may have a decreased risk of stroke, and have a shorter stay in the hospital after surgery.

Port-Access coronary artery bypass (PACAB) makes use of the heart-lung machine but, instead of cutting through the sternum and other bone and chest muscle, the surgeon makes small incisions in the chest and chest arteries or veins from the leg are attached to the heart to bypass the clogged coronary artery or arteries.

Minimally invasive heart surgery can also be used for epicardial lead placement in which leads are placed in the heart for cardiac resynchronization therapy.

Patients who have one of these procedures instead of open-heart surgery have a lower risk of complications associated with the heart-lung machine such as stroke, lung problems, kidney problems and problems with mental clarity and memory. In addition to reduced complications, other benefits include a smaller incision, a smaller scar, reduced risk of infection, less bleeding, less pain and trauma and faster recovery and reduced hospital costs.