Overview

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 don't cut through the breastbone (sternotomy). Rather, they operate between the ribs, which may result in less pain and a quicker recovery for many people.

In minimally invasive surgery, your heart surgeon may have a better view of some parts of your heart than in open-heart surgery. Similar to open surgery, some minimally invasive heart surgery procedures may require stopping your heart temporarily and diverting blood flow from your heart using a heart-lung bypass machine.

Minimally invasive heart surgery may be performed to treat a variety of heart conditions.

Mayo Clinic's approach

Why it's done

Many types of heart procedures may be conducted with minimally invasive heart surgery. Minimally invasive heart procedures may include:

  • Mitral valve repair and replacement
  • Tricuspid valve repair and replacement
  • Aortic valve replacement
  • Atrial septal defect and patent foramen ovale closure
  • Atrioventricular septal defect surgery
  • Maze procedure for atrial fibrillation
  • Coronary artery bypass surgery
  • Saphenous vein harvest for coronary artery bypass surgery

Potential benefits

Minimally invasive heart surgery isn't an option for everyone, but it can offer potential benefits in those for whom it's appropriate. Potential benefits of minimally invasive heart surgery compared with open-heart surgery 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

Who benefits from minimally invasive heart surgery

Not everyone is a candidate for minimally invasive heart surgery. Your doctor and treatment team will work with you to determine whether minimally invasive heart surgery is an option to treat your condition.

Your doctor and treatment team may evaluate you to determine whether you're a candidate for minimally invasive heart surgery. In an evaluation, your doctor may conduct a physical examination, review your medical history and perform tests.

Minimally invasive heart surgery can be a complex surgical procedure. Doctors may recommend you have the surgery at a medical center with surgeons and a surgical team experienced and trained in conducting minimally invasive procedures.

Risks

Minimally invasive surgery can involve risks similar to open-heart surgery, such as:

  • Bleeding
  • Stroke
  • Wound infection
  • Irregular heart rhythms (arrhythmias
  • Death

How you prepare

Before minimally invasive heart surgery, your doctor and treatment team will explain to you what to expect before, during and after the surgery and potential risks of the surgery.

Your doctor and team will discuss concerns you may have about your minimally invasive heart surgery. Your doctor or another member of your treatment team may discuss with you advance directives or other information to consider prior to your surgery.

You may need to have your hair shaved off at the locations of your body where the procedure will take place.

Before being admitted to the hospital for your surgery, talk to your family about your hospital stay and discuss help you may need when you return home. Your doctor and treatment team may give you specific instructions to follow during your recovery when you return home.

Food and medications

Talk to your doctor about:

  • When you can take your regular medications and whether you can take them before your surgery
  • When you should stop eating or drinking the night before the surgery

Clothing and personal items

Your treatment team may recommend that you bring several items to the hospital, including:

  • A list of your medications
  • Eyeglasses, hearing aids or dentures
  • Personal care items, such as a brush, comb, shaving equipment and toothbrush
  • Loosefitting, comfortable clothing
  • A copy of your advance directive
  • Items that may help you relax, such as a portable music player or books

During surgery, avoid wearing:

  • Jewelry
  • Eyeglasses
  • Contact lenses
  • Dentures
  • Nail polish

Precautions regarding medications and allergies

Talk to your doctor about:

  • Any medications you have brought to the hospital and when you should take medications on the day of the procedure
  • Allergies or reactions you have had to medications

What you can expect

During the procedure

Minimally invasive heart surgery includes robot-assisted heart surgery, thoracoscopic surgery or surgery through a small incision in the chest (direct less invasive access heart surgery). In all types of minimally invasive procedures, surgeons reach your heart through small incisions between the ribs of your chest. For some procedures, you may be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.

Robot-assisted heart surgery

In robot-assisted heart surgery, the exact maneuvers performed in traditional open-chest surgery are duplicated by the surgeon using robotic arms, rather than his or her hands.

During this procedure, your surgeon works at a remote console and views your heart in a magnified high-definition 3-D view on a video monitor.

From the remote console, your surgeon's hand movements are translated precisely to the robotic arms at the operating table, which move similarly to the human wrist.

A second surgeon and surgical team assists at the operating table, changing surgical instruments attached to the robotic arms.

Thoracoscopic surgery

In thoracoscopic surgery (sometimes referred to as a minithoracotomy), your surgeon inserts a long, thin tube (thoracoscope) containing a tiny high-definition video camera into a small incision in your chest.

Your surgeon repairs your heart using long instruments inserted through small incisions between your ribs.

After the procedure

You'll generally spend a day or so in the intensive care unit (ICU). You'll be given fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your heart and chest. You may be given oxygen.

After the ICU, you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital can vary, depending on your condition and surgery.

Your treatment team may monitor your condition and watch for signs of infection in your incision sites. Your team may check your blood pressure, breathing and heart rate. Your treatment team will also work with you to manage pain you may experience after surgery.

Your treatment team may instruct you to walk regularly to gradually increase your activity and to do breathing exercises as you recover.

Your doctor may give you instructions to follow during your recovery, such as watching for signs of infection in your incisions, properly caring for incisions, taking medications, and managing pain and other side effects after your surgery.

Results

After minimally invasive heart surgery, you may have an improved quality of life and reduced symptoms.

Your doctor will instruct you about when you can return to daily activities, such as working, driving and exercise.

You'll need to attend regular follow-up appointments with your doctor. You may have several tests to evaluate and monitor your condition.

Your doctor may instruct you to incorporate healthy lifestyle changes — such as physical activity, a healthy diet, stress management and avoiding tobacco use — into your life.

Your doctor may recommend that you participate in cardiac rehabilitation — a program of education and exercise designed to help you improve your health and help you recover after heart surgery.

Minimally invasive heart surgery care at Mayo Clinic

Dec. 29, 2017
References
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  5. Pope NH, et al. Minimally invasive valve surgery. Journal of Cardiovascular Translational Research. 2014;7:387.
  6. Lamelas J, et al. Minimally invasive valve surgery: When less is more. Seminars in Thoracic and Cardiovascular Surgery. 2015;27:49.
  7. Lee R. Surgical ablation to prevent recurrent atrial fibrillation. http://www.uptodate.com/home. Accessed May 26, 2016.
  8. Connolly HM. Surgical and percutaneous closure of atrial septal defects in adults. http://www.uptodate.com/home. Accessed July 25, 2016.
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Minimally invasive heart surgery