Minimally Invasive Heart Procedures

Posted: April 1, 2005

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
This procedure is only applicable for patients requiring a single or double bypass grafting in specific heart-anatomic locations. Surgical candidacy is a determination made by the cardiothoracic surgeon.

A 3-4" incision is placed between the ribs. A blocked artery is bypassed with a vessel taken from another part of the body, allowing blood to flow freely to the heart again. The patient's circulation does not travel through the heart-lung machine (cardiopulmonary bypass).

The advantages of the MIDCAB are a smaller incision (avoiding a sternotomy incision) and the fact that cardiopulmonary bypass is not required. There is limited exposure to the heart during the MIDCAB procedure and therefore is applicable for only select patients.

Without needing the heart-lung machine other complications are avoided such as stroke, renal failure and related impairments. Overall the healing process is quicker.

Minimally Invasive Valve Replacement (Aortic/Mitral)
The heart has four valves inside it. These valves function as one-way doors to keep blood moving in one direction through the heart. If problems with one or more valves develop, the heart works harder to get blood out to the body. Examples include insufficiency (regurgitation) and stenosis (incomplete valve opening). During heart valve surgery one or more valves are repaired or replaced.

A mini-sternotomy approach is used for replacing an aortic valve. A mitral valve replacement is performed through a small inframammary incision through a small right anterior thoracotomy. Also known as "keyhole" cardiac surgery, the small incision does not accommodate full access to the heart.

If the valve(s) can be mended the surgeon performs the needed repairs. If replacement is indicated, part or all of the damaged valve(s) and its supportive structures may be removed.

During repair, a ring may be sewn around the valve's opening to tighten it while other parts of the valve may be shortened, separated, made stronger or cut depending on what is needed to improve the function.

During replacement, a prosthetic valve (mechanical or biological) is used.

Not every cardiac patient is a candidate for minimally invasive valve replacement because of the limited "surgical exposure" to the heart. The incisions are much smaller than for traditional valve surgery and therefore heal faster.

Source: Milwaukee Institute of Minimally Invasive Surgery (www.mimis.us)

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