Minimally Invasive Heart Surgery

Overview

Minimally invasive heart surgery (also called keyhole surgery) is when a conventional operation is performed on or inside the heart using small incisions. The surgeon also sometimes uses specialized instruments.

Who Is a Candidate for Minimally Invasive or Robotic Surgery?

There are many ways to reach the heart for surgery. Surgeons at Cleveland Clinic always try to use the smallest incision to provide the safest and most successful surgery. Your surgical team will carefully compare the advantages and disadvantages of minimally invasive techniques with those of traditional surgery techniques. Your surgeon will decide the best approach for you based on several factors, including the type or heart disease you have and how severe it is; your age, medical history and lifestyle; and results of tests done before surgery.

Traditional Heart Surgery

traditional heart surgery

Traditional heart surgery uses an incision through the middle of your chest, through the breast bone. The incision is about 6 to 8 inches long.

This is the safest and most commonly used incision for patients who need complicated heart surgeries, reoperations, multiple coronary artery bypass procedures or complex aorta procedures.

Types of Minimally Invasive Heart Surgeries

Cleveland Clinic surgeons have performed minimally invasive heart surgery since the mid 1990s. The first surgeries of this type were mitral and aortic valve surgeries. Now, a wide range of procedures can be done using minimally invasive techniques to help make recovery faster and more comfortable.

Sometimes, minimally invasive surgery includes a partial sternotomy. This involves cutting through part of the breast bone. When possible, the surgeon can avoid cutting the breast bone and, instead, make one or more small incisions through the muscles between the ribs. This technique is called a mini-thoracotomy.

Robotically assisted heart surgery

Most types of robotically assisted heart surgery are used to treat patients with mitral regurgitation (leaky mitral valve). Robotically assisted heart surgery can be used for:

Procedure Details

Types of Incisions Used in Minimally Invasive Heart Surgery

Partial Sternotomy - through part of the breast bone

A 3- to 4-inch long incision is made through the sternum, and the breast bone is separated in that area so the surgeon can see the part of the heart that needs surgery.

partial sternotomy

Used for mitral valve, tricuspid valve, epicardial lead placement, atrial septal defect (ASD), patent foramen ovale (PFO), myxoma, and aortic valve surgeries.

partial sternotomy

Used for ascending aorta, aortic valve, mitral valve, tricuspid valve, two valves, transaortic TAVR, ASD, PFO, myxoma and fibroblastoma surgeries.

Mini-thoracotomy

The surgeon avoids cutting through the breastbone and, instead, cuts into muscles between the ribs to reach the heart.

Mini-thoracotomy

Used for mitral valve, tricuspid valve, ASD, PFO, myxoma surgeries.

Mini-thoracotomy

Used for aortic valve, transaortic TAVR and transaortic TEVAR surgeries.

Mini-thoracotomy

Used for transapical TAVR, transapical TEVAR and epicardial lead placement surgeries.

Robotically assisted heart surgery

robotically assisted heart surgery

Used for mitral valve, tricuspid valve with mitral, ASD, PFO, atrial myxoma and fibroblastoma surgeries.

Robotically assisted heart surgery is performed through a small working incision and three other small incisions (ports) that are made in the spaces between the ribs. The surgical instruments are attached to the robotic arms. The instruments and a tiny camera are placed through the ports. Motion sensors are attached to the robotic “wrist,” so the surgeon can control the instruments.

Robotically assisted mitral valve surgery is performed using only the small port incisions.

Risks / Benefits

Benefits of Minimally Invasive Surgical Techniques

The benefits of minimally invasive surgery include:

  • Small incisions
  • Small scars

Most patients also have

  • Less pain
  • Shorter hospital stay after surgery
  • Lower risk of infection
  • Lower risk of bleeding and blood transfusion
  • Shorter recovery time and faster return to normal activities/work

Recovery and Outlook

Recovery

If you have minimally invasive or robotic surgery, you will probably be able to go home 2 to 5 days after surgery. Your healthcare team will follow you closely while you are in the hospital and help you recover as quickly as possible. When you are ready to leave the hospital, you will get instructions on your recovery and return to work, including guidelines for activity, driving, incision care and diet.

In general, it takes about 1 to 4 weeks before you will feel well enough to return to work (if your job doesn’t involve physical activity), resume driving and take part in most nonstrenuous activities, so long as you have stopped taking pain medications. You can usually get entirely back to your normal routine in 5 to 8 weeks after surgery. It is important to know that everyone has a different recovery and your healthcare team will give you guidelines based on how well you are doing.

Healthy Living

To keep your heart healthy after surgery, it is important to make lifestyle changes and take your medications as prescribed. Heart-healthy lifestyle changes that are important to your recovery include:

  • Quitting smoking
  • Controlling high cholesterol
  • Managing high blood pressure and diabetes
  • Exercising regularly
  • Maintaining a healthy weight
  • Eating a heart-healthy diet
  • Taking part in a cardiac rehabilitation program, as recommended
  • Following up with your doctor for regular visits

Resources

If you would like to find out if you are a candidate for minimally invasive mitral valve surgery or learn more about minimally invasive heart surgery, contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Last reviewed by a Cleveland Clinic medical professional on 07/22/2019.

References

  • Gillinov M, Mihaljevic T. The Future of Mitral Valve Surgery. Tex Heart Inst J. 2012; 39(6):840–841. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528247/ (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528247/)
  • Iribarne A, Easterwood R, Chan EYH, Yang J, Soni L, Russo MJ, Smith CR, Argenziano M. The golden age of minimally invasive cardiothoracic surgery: current and future perspectives. Future Cardiol. 2011 May; 7(3):333–346.
  • Johnston DR, Roselli EE. Minimally invasive aortic valve surgery: Cleveland Clinic experience. Ann Cardiothorac Surg 2015;4(2):140-147 :
  • Malaisrie SC, Barnhart GR, Farivar RS, Mehall J, Hummel B, Rodriguez E, Anderson M, Lewis C, Hargrove C, Ailawadi G, Goldman S, Khan J, Moront M, Grossi E, Roselli EE, Agnihotri A, Mack MJ, Smith JM, Thourani VH, Duhay FG, Kocis MT, Ryan WH. Current era minimally invasive aortic valve replacement: techniques and practice. J Thorac Cardiovasc Surg. 2014 Jan;147(1):6-14. Epub 2013 Nov 1.
  • Mihaljevic T, Koprivanac M, Kelava M, Avi Goodman A, Jarrett C, Williams SJ, Gillinov AM, Bajwa G, Bonatti J, Blackstone EH. Value of robotically assisted surgery for mitral valve disease. JAMA Surg. 2014 July; 149(7): 679-686.
  • Secchin Canale L, Mihaljevic T, Nair R, Bonatti J. Robotically assisted totally endoscopic coronary artery bypass surgery. J Thorac Dis. 2013 November; 5(Suppl 6): S641–S649.
  • Society of Thoracic Surgeons (http://www.sts.org/)

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