Understanding the technology
About This Technology.
Minimally invasive cardiac surgery (MICS) is heart surgery performed through a small incision, usually between the ribs on the right side, without dividing the whole breastbone. The surgeon uses long-shafted instruments, sometimes with a small camera. It is mainly used for mitral and aortic valve surgery and for closing certain holes in the heart wall in eligible patients.
What Is Minimally Invasive Cardiac Surgery?
In conventional heart surgery, the surgeon divides the breastbone down the middle (sternotomy) to reach the heart. Minimally invasive cardiac surgery (MICS) uses a smaller route, such as an incision between the ribs on the right side (mini-thoracotomy) or an incision that opens only the upper part of the breastbone (mini-sternotomy). The repair on the heart is the same; what differs is the way in.
Because the working space is narrow, the surgeon uses long-shafted instruments and may be assisted by a small camera that shows the heart on a screen. The heart-lung machine is still used, and in a mini-thoracotomy it is usually connected through blood vessels in the groin. Transesophageal echocardiography (TEE), an ultrasound of the heart taken from the esophagus, helps the team assess the valves during surgery.
Operations That Can Be Done with MICS
- Mitral valve repair or replacement
- Aortic valve replacement
- Tricuspid valve surgery in selected patients
- Closure of an atrial septal defect (ASD) that is not suitable for catheter closure
- Bypass of one or two specific coronary arteries, sometimes combined with stenting as hybrid revascularization
Who Is Suitable
Not every patient can have MICS. The team assesses suitability with echocardiography and a CT scan, which show the shape of the chest, the position of the heart, and the condition of the aorta and the blood vessels in the groin. Surgery on several valves at once, bypass of many coronary arteries, scar tissue from previous chest surgery, or severe peripheral artery disease are usually handled more safely through the breastbone.
What You Can Expect
Preparation, general anesthesia, and monitoring in the cardiovascular ICU after surgery are essentially the same as for other heart operations. The difference is the wound. With the approach between the ribs, the breastbone is not divided, so restrictions related to breastbone healing usually do not apply. Pain around the ribs can still be felt in the early days and is treated with medication. Your doctor will still set activity limits suited to your condition.
Limitations and Risks
MICS is still major heart surgery, with risks similar to conventional surgery, such as bleeding, heart rhythm problems, and stroke. There are also specific risks, such as problems with the groin blood vessels where the heart-lung machine tubes are placed. If access proves inadequate or bleeding occurs, the surgeon may switch to opening the breastbone for your safety. In a clinical trial of mitral valve repair, physical recovery and safety after mini-thoracotomy did not differ significantly from sternotomy, so the approach is chosen based on anatomy and the surgical team's judgment.
Clinical use
Uses and Benefits.
Whether this technology suits your condition is decided by a doctor after an evaluation.
- Mitral valve repair or replacement between the ribs
- Aortic valve replacement through a small incision
- Tricuspid valve surgery in selected patients
- Surgical closure of an atrial septal defect (ASD)
- Bypass of one or two specific coronary arteries
- The surgical part of hybrid revascularization with stenting
Benefits for the Doctor's Assessment
The Breastbone Stays Intact
With the approach between the ribs, the heart is reached without dividing the breastbone, so there is no breastbone wound that needs to heal after surgery.
A Smaller Incision
The incision between the ribs or through part of the breastbone is shorter than a conventional incision. In some patients, it follows the skin fold below the chest.
Suitability Assessed in Advance
Echocardiography and a CT scan are used to check the shape of the chest, the aorta, and the groin blood vessels before MICS is chosen, so the approach fits your anatomy.
Switching to the Standard Approach If Needed
If conditions during surgery require it, the team can widen the access or switch to opening the breastbone. This possibility is explained before you give consent.
Brief Technical Information
- Procedure type
- Heart surgery through a small incision (mini-thoracotomy or mini-sternotomy)
- Anesthesia
- General anesthesia
- Circulatory support
- Heart-lung machine when the operation requires it
- Special equipment
- Long-shafted surgical instruments for working through a small incision
- Service location
- Operating Theatre, Advanced Cardiovascular Surgical Care
