Minimally invasive cardiac surgery allows the patient to recover faster and reduces blood loss.

Traditional heart surgery typically requires exposure of the heart and its vessels through median sternotomy (dividing the breastbone) and a 6 to 8 inch incision. Minimally invasive heart surgery (also called keyhole surgery) is performed through small incisions, sometimes using specialized surgical instruments. The incision used for minimally invasive heart surgery is about 3 to 4 inches.

Not everyone is a candidate for these surgical techniques. Your surgeon will review the results of your tests to determine if you are a candidate for minimally invasive surgery. The surgical team will carefully compare the advantages and disadvantages of minimally invasive techniques against traditional surgery techniques.

Benefits of minimally invasive surgical techniques

The benefits of minimally invasive techniques include:
• Small incisions and small scar.
• Shorter hospital stay after surgery.
• Low risk of infection.
• Less postoperative pain.
• Low risk of bleeding and blood transfusion.
• Shorter recovery time and faster return to normal activities/work.

Recently, there has been a surge in the body of published literature on the long-term outcomes of MICS, with most reports suggesting that major cardiac operations that have traditionally been performed through a median sternotomy can be performed through a variety of minimally invasive approaches with equivalent safety and durability.

Minimally invasive Mitral Valve Repair

Mitral valve surgery has been one of the areas of cardiac surgery most widely influenced by minimal access approaches. Various approaches have been described for MIMVS. The most popular approach to MIMVS is through a right mini-thoracotomy. Various technological innovations have made such approaches feasible. In addition to the technology developed for video- and robotically-assisted surgery, several innovations in surgical instruments and cannulation techniques were necessary for MIMVS. For example, arterial and venous perfusion cannulae have allowed for the development of percutaneous perfusion techniques that permit maximal exposure in the operating field.

Minimally invasive aortic valve replacement

Various techniques for obtaining appropriate exposure have been developed and put into practice. With the greater use of MIAVR, there is a growing understanding of the outcomes following MIAVR compared with traditional aortic valve replacement (AVR) with median sternotomy, including survival rates, perioperative times and complications. Currently, the most common approach used is the mini-sternotomy, using a J, inverted T or other similar incision. This approach provides several advantages over other incisions. It provides adequate exposure while minimizing postoperative pain and minimally affecting thoracic cage stability. If necessary, it can be extended to provide additional exposure. Several cannulation methods have also been used, including completely peripheral (femoral–femoral) or central cannulation (generally preferred), given that peripheral vascular injury is avoided. Most studies have demonstrated no difference in morbidity or mortality between MIAVR and conventional AVR (CAVR). Although early studies associated MIAVR with longer CPB and aortic cross-clamp times, operative times have improved and are comparable between groups in more recent studies. This suggests that there is a learning curve, but also that minimally invasive approaches do not require longer operative times in experienced hands.