Minimally invasive heart surgery is performed through small incisions, using specialized surgical instruments. The incision used for minimally invasive heart surgery is about 2 to 3 inches instead of the 6- to 8-inch incision required for traditional open heart surgery. The benefits of minimally invasive heart surgery techniques include:
- Preserving the breastbone (sternum)
- Preserving the anatomic and physiologic mechanics of the chest
- Smaller incision resulting into smaller scar
- Less post-operative pain
- Shorter length of stay after surgery: the average stay is 3-5 days after minimally invasive heart surgery, while it is 7 to 10 days after traditional heart surgery
- Shorter recovery time and return to regular activities: for patients who undergo minimally invasive heart surgery, the average recovery time is 1-4 weeks, while the average recovery time after traditional heart surgery is 6 to 8 weeks.
Minimally invasive procedures that the cardiac surgeons at Beth Israel Medical Center currently perform include:
- Mitral valve repair and replacement via a right mini-thoracotomy
- Aortic valve replacement via a partial upper sternotomy or a right mini-thoracotomy
- Tricuspid valve repair and replacement via a right mini-thoracotomy
- Atrial septal defect (ASD) closure, including patent foramen ovale (PFO)
- Atrial fibrillation surgery (Maze procedure)
- Saphenous vein harvest for coronary artery bypass surgery
- Radial artery harvest for coronary artery bypass surgery via 1.5 inches incision at the wrist
Replacement means the diseased valve is removed and a new valve is inserted in its place. Repair of the valve means that the valve is mended to help it work better.
The right mini-thoracotomy is performed with a 2- to 3-inch skin incision created in a skin fold on the right chest below the breast, providing an excellent cosmetic result. The heart is approached between the ribs, providing the surgeon access to the mitral valve. The surgeon inserts special surgical instruments through the incision to perform the valve repair or replacement, and may be an appropriate approach for patients who require combined mitral valve and aortic valve procedures. Results with this approach are excellent.
A partial upper sternotomy includes a 2- to 3-inch skin incision and division of the upper portion of the sternum, providing the surgeon access to the aortic valve to perform the replacement. In contrast, a traditional sternotomy requires an 8- to 10 -inch incision down the entire sternum, spreading the chest and interfering with the lung mechanics. The partial upper sternotomy offers the surgeon an excellent view of the aortic valve.
In general, you may be able to return to work (if you have a sedentary job), resume driving and participate in most non-strenuous activities within 1 to 4 weeks after routine minimally invasive heart surgery. You can resume heavy lifting and other more strenuous activities within 5 to 8 weeks after surgery. Your health care team will provide specific guidelines based on your rate of recovery.