About Minimally Invasive Heart Surgery (MICS)
Is the pre-operative evaluation different with MICS?
In general, all patients being evaluated for cardiac surgery are thoroughly screened. Firstly, we must make sure that the surgery is indeed indicated. Many patients avoid visiting a heart surgeon as they fear they will be hastily taken to the operating room. To the contrary, our job is not only to know when to operate, but also when not to operate. This requires experience and sound judgment in order to counsel our patients and their families well. If surgery is indicated, then the actual approach – minimally invasive or traditional – does not dictate a particular pre-operative evaluation. We will be best prepared to deal with any situations that are specific to our patients.
How do you do the surgery through such small holes?
Evolving technology has allowed development of instruments and techniques such that many surgeries can be performed through the smaller incisions. Although many of the operations pose additional challenges with limited access, the fundamental concepts governing cardiac repair remain similar as those performed in the open manner.
What are the complications of MICS? How do they differ from traditional heart surgery?
Heart surgery, of any type, has inherent risks regardless of a particular approach. Commonly cited complications include infection, bleeding, stroke, electrical conduction problems, organ failure, arrhythmias, and death. Fortunately, these complications, even in the open operations are relatively rare. Isolated valve operations should carry a mortality rate <1-2%.
Although many procedures can be performed without the use of the cardiopulmonary bypass machine, valvular operations require the use of the heart-lung machine. Typically, the access for this machine is through tubes placed in the groin artery and vein. Patients can experience numbness or drainage at the groin incision site. In addition, some patients will experience temporary numbness under their right breast at the site of the chest incision. As mentioned above, MICS typically carries lower complication rates because there is less risk of bleeding, earlier ambulation and return to activity, and less risk of infection.
