What is Minimally Invasive Heart Surgery?

There is no specific indication as to when minimally invasive surgery should be done. However, as far as is possible, we try to make it the preferred option since it leads to a rapid patient recovery.

When the patient is a candidate for these procedures, a preoperative study is performed for confirmation, especially of the vascular anatomy.

There is no difference with conventional surgery. Once the surgery is indicated and the preoperative study, which confirms the patient can undergo minimally invasive surgery, is complete the patient is scheduled for admission to the hospital.

The intervention is performed in the same operating room as conventional cardiac surgery. The main difference with conventional cardiac surgery is that, instead of cutting the breastbone, small incisions are made in the side of the chest (between the ribs) where the surgical instruments and camera enter.

In some cases, a heart-lung machine (to act temporarily as a heart and lung) needs to be connected. If so, a small incision is first made in the right groin to access the femoral artery and vein, which are used for cannulation and connection to the heart-lung machine.

Once all the instruments have been inserted, extracorporeal circulation begins, where required, and the operation proceeds.

In some cases, surgery is performed with the support of a robotic system to provide more accuracy for the surgeon.

After minimally invasive cardiac surgery, the patient is normally extubated in the same operating room and subsequently transferred to the Intensive Care Unit. In selected cases, an ultra-fast-track protocol is followed. In this case, the patient is awakened in the operating room then transferred to the Resuscitation Area, instead of being transferred to the Intensive Care Unit. After about 6 hours, the patient returns to the conventional hospitalisation room.

In general, the first day after the operation, patients are transferred to the hospitalisation room where the drains are also removed. This rapid mobilisation to the ward means patients can start walking or moving the same day.

Because minimally invasive cardiac surgery means a faster recovery for patients, they can return home after 2-3 days, as long as their evolution is satisfactory and the postoperative study is completed. This study consists of a blood test, chest x-ray, electrocardiogram (ECG) and echocardiogram.

Then, after about 2 weeks, an appointment with the advanced practice nurse is made, followed by one with the responsible surgeon.

The complications are the same as in conventional surgery:

• The most common complication is postoperative bleeding, despite it being infrequent.
• Seromas (fluid accumulation) may develop in the femoral incision.
• Also, atrial arrhythmias, which are usually controlled quickly by medication.

The following is recommended during the postoperative period: