VALVE AND AORTA

1. Minimally Invasive Cardiac Surgery

What is minimally invasive cardiac surgery?

Most cardiac operations today are performed through a sternotomy, which involves splitting the entire breastbone. Minimally invasive cardiac surgery encompasses a variety of operations performed through incisions that are substantially smaller and less traumatic than the standard sternotomy. Minimally invasive incisions measure about 3 to 4 inches compared to 8 to 10 sternotomy incisions. Specialized handheld and robotic instruments are used to project the dexterity of the surgeon’s hands through these small incisions in performing the operations.

Standard Sternotomy Incision​
This 8 to 10 inch incision splits the entire breastbone.

Mini-Sternotomy Incision
This 4 to a5 inch incision just splits the upper third of the breastbone.

Mini-Thoracotomy Incision
This 3 to 4 inch incision is made between the ribs whereby no bone is cut.

Port-access Incision
Robotic instruments are passed through several 1/2 inch incisions between the ribs.

What are the benefits of minimally-invasive cardiac surgery?

Minimally invasive surgery confers many advantages over standard approaches derived largely from the reduced trauma to the chest wall tissues. The benefits of minimally invasive cardiac surgery include:

  • Smaller incisions
  • Smaller scars
  • Reduced infection risk
  • Less blood loss
  • Less pain
  • Shorter hospital stays. Stays after minimally invasive operations are from 3 to 5 days compared to 5 to 7 days for traditional sternotomy-based cardiac operations.
  • Fewer physical restrictions. Patients undergoing standard incision cardiac operations are restricted from driving an automobile or lifting objects weighing more than 5 pounds while patients undergoing minimally invasive cardiac surgery are not subject to these restrictions
  • Shorter recovery time. Recovery times after minimally invasive operations from 2 to 4 weeks compared to 6 to 8 weeks for standard sternotomy-based cardiac operations.

What surgeries can be done by minimally invasive methods?

Operations using a minimally-invasive approach:

  • Coronary artery bypass grafting(CABG).
  • Mitral valve Repair/Replacement (MV Repair/ Replacement).
  • Atrial septal defect closure.

2. Heart Transplant

A heart transplant is a surgery that removes a diseased heart and replaces it with a healthy heart from a deceased donor to improve your quality of life and increase your lifespan.

Overview

Most heart transplants are done on patients who have end-stage heart failure, a condition in which your heart is severely damaged or weakened, and on people who have failed other treatment options. End-stage heart failure may be caused by conditions such as coronary heart disease, viral infections, or hereditary conditions. In rare instances, a heart transplant may be performed at the same time as a lung transplant in patients who have severe heart and lung disease.

You may be eligible for heart transplant surgery if you have severe heart disease that does not respond to other treatments. If you are otherwise healthy enough for surgery, you will be placed on the National Organ Procurement and Transplantation Network’s waiting list. This national network handles the organ-sharing process for the United States. If a match is found, you will need to have your heart transplant surgery right away.

Heart transplant surgery will be done in a hospital. You will have general anesthesia and will not be awake during the surgery. You will receive medicine through an intravenous (IV) line in your arm. A breathing tube connected to a ventilator will help you breathe. A surgeon will open your chest, connect your heart’s arteries and veins to a heart-lung bypass machine, and remove your diseased heart. The body’s arteries and veins will be taken off the bypass machine and reconnected to the healthy donor heart. The heart transplant is complete after the surgeon closes your chest.

After the surgery, you will recover in the hospital’s intensive care unit (ICU) and stay in the hospital for up to three weeks. During your recovery, you may start a cardiac rehabilitation program. Before leaving the hospital, you will learn how to keep track of your overall health; monitor your weight, blood pressure, pulse, and temperature; and learn the signs of heart transplant rejection and infection. For the first three months after leaving the hospital, you will return often for tests to check for infection or rejection of your new heart, to test your heart function, and to make sure that you are recovering well.

Practicing good hygiene, obtaining routine vaccines, and making healthy lifestyle choices are very important after a heart transplant to reduce your risk of infection. Regular dental care is also important. Your doctor or dentist may prescribe antibiotics before any dental work to prevent infection. Following your doctor’s advice will help you recover and stay as healthy as possible.

Heart transplant has some serious risks. Primary graft dysfunction happens when the donor heart fails and cannot function. This is the most frequent cause of death for the first month after the transplant. Your immune system also may reject your new heart. Rejection is most likely to occur within six months after the transplant. You will need to take medicines for the rest of your life to suppress your immune system and help prevent your body from rejecting your new heart. These medicines weaken your immune system and increase your chance of infection. Their long-term use also can increase your risk for cancer, cause diabetes and osteoporosis, and damage your kidneys. Cardiac allograft vasculopathy is a common and serious complication of a heart transplant. Cardiac allograft vasculopathy is an aggressive form of atherosclerosis that over months or a few years can quickly block the heart’s arteries and cause the donor heart to fail. Over time, your new heart may fail due to the same reasons that caused your original heart to fail. Some patients who have a heart transplant that fails may be eligible for another transplant.

Despite these risks, heart transplant has a good success rate that has improved over many decades of research. Recent survival rates are about 85 percent at one year after surgery, with survival rates decreasing by about three to four percent each additional year after surgery because of serious complications. Mechanical circulatory support, possibly from left ventricular assist devices, may be an alternative to heart transplant. But more research is needed to determine long-term survival rates for these new devices.