Mount Sinai Heart Institute

Minimally Invasive Cardiac Surgery

What is it?

Standard heart surgery typically requires exposure of the heart and its vessels through median sternotomy (dividing the breastbone), considered one of the most invasive and traumatic aspects of open-chest surgery. A minimally invasive approach allows access to the heart through small incisions and without stopping the heart, without separating the breastbone (sternum) and ribcage, and without requiring a heart-lung machine to be used.

Different Approaches

There are two approaches that are commonly used for minimally invasive cardiac surgery.

Port-access coronary artery bypass (referred to as PACAB or PortCAB)

In PACAB, the heart is stopped and blood is pumped through an oxygenator or "heart-lung" machine to receive oxygen during the surgery. This is called "cardiopulmonary bypass." Then small incisions are made in the chest. Chest arteries or veins from the legs are attached to the heart to "bypass" the clogged coronary artery or arteries. The surgical team passes instruments through the ports to perform the bypasses.

Minimally invasive coronary artery bypass (referred to as MIDCAB)

MIDCAB is used to avoid the heart-lung machine. It's done while the heart is still beating and is selected for use when only one or two arteries will be bypassed. MIDCAB uses a combination of small holes, or "ports", in the chest and a small incision made directly over the coronary artery to be bypassed. The heart surgeon usually detaches an artery from inside the chest wall and re-attaches it to the clogged coronary artery farthest from the occlusion.

Advantages

Recovery

After minimally invasive valve surgery, the patient receives continued cardiac monitoring in the intensive care unit. Once the patient is able to breathe on his/her own, the breathing tube is removed. Any medications to treat poor cardiac function or manage blood pressure are discontinued as cardiac function improves and blood pressure stabilizes.

Blood drainage tubes protruding from the chest cavity are removed once internal bleeding decreases. The patient also may be equipped with an external cardiac pacing system to maintain the heart rate. The pacing is terminated once the heart is beating at an adequate rate free of arrhythmia. A warming blanket may be used to warm the patient's core temperature decreased by the surgical exposure.

The duration of the post-operative hospital stay is reduced by one to two days in these procedures. Pain also should be reduced. Homecare for the wound is described prior to discharge, and instructions for responding to adverse events after discharge also are provided. Patients who have undergone these procedures should expect to return to normal activities sooner than those who have undergone traditional coronary artery bypass grafting.

Last update: 11/19/10

Cardiac Surgical Procedures