Cardiac Surgery

Over the years minimal access surgery was available for most other surgical specialties as with laparoscopic abdominal surgery, orthopedic and neurosurgery. It is now available for heart surgery although limited to a few highly specialized centers. In fact, the Cardiac surgeons at the Minimal Access Surgery Center at Apollo Hospitals, Bangalore are the only surgeons routinely performing this type of surgery in India.

Minimally invasive heart surgery is performed through small skin incisions measuring 2 to 3 inches. The sternum is split only partially (or sometimes incision is made in between the ribs) exposing only that part of the heart that needs to be operated on. For aortic valve surgery only the upper part of the sternum is split while for mitral valves the lower part of the sternum is split. Two thirds of the sternal body remains intact and a small part of the heart is visualized.

In addition to a specifically trained and skilled surgeon, a good anesthesiologist with excellent transesophageal echocardiography skills is a must.

The technique of establishing cardiopulmonary bypass also differs from conventional heart surgery with most of the cannulation done in the groin and very little of the aorta manipulated. This means a significantly lower incidence of sternal dehiscence as well as cerebrovascular events.  Recovery time is fast with patients extubated early, mobilized on the same day and discharged as early as the 3rd postoperative day. Blood transfusions are rarely required eliminating transfusion related infection and lung toxicity. Hospital stay is reduced to half of what is usually required. This reduces the chance of acquiring infections while in the hospital, while reducing health care costs to the community in general.  Faster wound healing allows the patient to return to work and a productive lifestyle in half the time required after conventional heart .

Not all heart diseases are suitable for this kind of approach. Likewise not all kinds of patients are suitable. Heart diseased suitable for this kind of surgery are

1. Aortic Valve Replacement or Repair
2. Mitral Valve Repair or Replacement
3. Some types of Aortic Aneurysms
4. Some types of holes in the heart (ASD, VSD)
5. CABG or Bypass Surgery where only one or two vessels need bypass. If vessels on the back of the heart need bypass, this technique may not be suitable