Services |Minimal Invasive Surgery

Overview

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In minimally invasive heart surgery, heart (cardiac) surgeons perform heart surgery through small incisions in the right side of your chest, as an alternative to open heart surgery. Surgeons operate between the ribs and don’t split the breastbone (sternotomy), which results in less pain and a quicker recovery for most people. In minimally invasive surgery, your heart surgeon has a better view of some parts of your heart than in open heart surgery. As in open surgery, minimally invasive heart surgery requires stopping your heart temporarily and diverting blood flow from your heart using a heart-lung machine..

Surgeons perform many minimally invasive heart surgeries, including:

  • Aortic valve surgery
  • Atrial septal defect closure, including patent foramen ovale
  • Atrioventricular canal defect (also called atrioventricular septal defect) surgery
  • Coronary bypass surgery (including “off-pump” bypass surgery, which is performed while the heart is still beating without a cardiopulmonary bypass machine) to treat coronary artery disease
  • Heart valve surgery to treat heart valve disease
  • Maze heart surgery to treat atrial fibrillation
  • Saphenous vein harvest (removing a vein from your leg) for coronary bypass surgery
  • Tricuspid valve surgery

Your doctor will work with you to determine if minimally invasive heart surgery is an option. If you’ve had prior heart surgery or heart disease, you generally aren’t a candidate for minimally invasive heart surgery. Your doctor also may perform tests and review your medical history to determine if you’re a candidate for minimally invasive heart surgery.

Advantages

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Minimally invasive heart surgery isn’t an option for everyone, but it offers many advantages in those for whom it’s appropriate:
Advantages may include:

  • Less blood loss
  • Lower risk of infection
  • Reduced trauma and pain
  • Shorter time in the hospital, faster recovery and quicker return to normal activities
  • Smaller, less-noticeable scars

Risks

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In people for whom minimally invasive heart surgery is appropriate, risks and complications are rare. You may experience these complications, which also may occur in other surgeries:

  • Bleeding
  • Heart attack
  • Stroke
  • Wound infection

Types of Minimally Invasive Heart Surgeries

Minimally Invasive Valve Surgery

Valve surgeries, including valve repairs and valve replacements, are the most common type of minimally invasive surgery, accounting for 87 percent of all minimally invasive cardiac surgeries performed at Cleveland Clinic.


Minimally Invasive CABG Surgery

Minimally invasive direct coronary artery bypass graft (MIDCABG) surgery is an option for some patients who require a left internal mammary artery bypass graft to the left anterior descending artery.
Saphenous (leg) vein harvest also may be performed using small incisions.
Several techniques for minimally invasive CABG surgery are being explored at Cleveland Clinic, including surgeries performed on a beating (off-pump) or non-beating (on-pump) heart.
Off-pump/beating heart bypass surgery allows surgeons to perform surgery on the heart while it is still beating. A medication may be given to slow the heart during surgery, but the heart keeps beating during the procedure. This type of surgery may be an option for patients with single-vessel disease (such as disease of the left anterior descending artery or right coronary artery).
Traditionally, CABG surgery is performed using a heart-lung bypass machine. This machine allows the heart’s beating to be stopped, so the surgeon can operate on a surface that is blood-free and still. The heart-lung bypass machine maintains life despite the lack of a heartbeat, removing carbon dioxide from the blood and replacing it with oxygen before pumping it around the body.
During off-pump/beating heart surgery, the heart-lung machine is not used. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and by bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.

Different Approaches to Minimally Invasive Heart Surgery

The term “minimally invasive surgery” covers a spectrum of approaches. The goal is to perform surgery through a smaller incision without compromising the safety and long-term results of conventional mitral valve repair. The advantage advantage of a small incision is mainly cosmetic (the scars are smaller and less visible). In some patients, the pain after surgery may be reduced and recovery from surgery is faster when surgery is done through a smaller incision. Operating through small incisions is however more technically demanding and in some cases could reduce the safety of the procedure. This page describes the various incisions, and you can read more about the associated benefits and disadvantages of each.

Lower Sternotomy

In this approach the surgeon makes a 4 inch incision over the lower aspect of the midline of the chest and divides only the lower portion of the breast bone to gain access to the valve. This limits the actual amount of opening, and thus chest wall trauma. Through this incision we can easily access the heart and all the major vessels and can perform most complex mitral valve repairs along with aortic valve replacement or coronary artery bypass grafting. This incision has the advantage that if the surgeon encounters problems, he or she can easily extend the incision and divide the remaining breast-bone and convert to the standard approach. When fully healed the lower sternotomy scar is concealed by clothing, even when the patient wears low-necked clothing. In some women the scar is well concealed by their brassiere. It is the most flexible approach to the heart, and it is the approach we use in most patients.


Mini-Thoracotomy

Mitral valve surgery can be carried out through a 2-3 inch incision, usually under the right breast, which allows the surgical team to see and work on the mitral valve directly. The patient is placed on the heart-lung machine either through the same chest incision or through the vessels in the groin via a 1 inch incision. Durable, simple and more complex mitral repairs can be performed, eliminating mitral regurgitation in a wide range of patients.


Thoracotomy

In this approach the surgeon makes a 4 to 6 inch incision in the right side (instead of middle) of the chest and gains access to the heart by going through the ribs. Some women prefer this incision because the scar may be placed underneath the breast crease and is therefore largely concealed. Access to the heart may be difficult in some cases making it more difficult to achieve a perfect repair.


Low Skin Incisions

Patients who are concerned about cosmesis, but who are not suitable for minimally invasive surgery, can request a low incision. The surgeon can make the standard skin incision start an inch lower and yet perform full division of the breastbone. The scar will therefore not be visible when wearing normal clothing. Patients who cannot have a minimally invasive operation, but who are concerned about the scar, can also request the services of our plastic surgeon to cosmetically close the incision.