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Minimally Invasive Cardiac Surgical Options
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Heart surgery is one of the major medical advancements of the last 30 years. Today, "minimally invasive" alternatives are gaining acceptance with surgeons worldwide. Conditions like atrial fibrillation and defective heart valves are just two such conditions that can now be treated with a more minimally invasive approach.
What Is a Minimally Invasive Procedure?
Minimally invasive procedures treat cardiac disorders by utilizing smaller incisions. As a result, patients typically experience less pain during recovery and usually are able to return to normal activities and work more quickly.
"Whether the problem is a malfunctioning valve, heart rhythm disorder, such as atrial fibrillation, or some other heart condition, I recommend that a patient see a cardiologist first, and that the cardiologist, together with a cardiac surgeon, identify appropriate treatment," says Jatinder Dhillon, M.D., medical director of cardiac surgery for John Muir Health.
Minimally Invasive Approach for Atrial Fibrillation
Atrial fibrillation is one such cardiac disorder that can be treated with a minimally invasive procedure. "Atrial fibrillation is the uncoordinated contraction of the upper chambers of the heart, called the atria," explains Andreas Kamlot, M.D., cardiothoracic surgeon on staff at John Muir Medical Center's Walnut Creek and Concord Campuses. "It is a very serious problem that may have life-threatening health risks, including an increased risk for heart failure and stroke." Roughly 2.2 million Americans have atrial fibrillation. During atrial fibrillation, the atria quiver instead of beating effectively. Blood isn't pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results.
Maze Procedure
In the past, most patients with atrial fibrillation were treated with medications that restore the heart's normal rhythm and blood thinners that aim to prevent the formation of blood clots that can cause strokes. "In many cases though, these patients had to take lifetime medication, which can have significant risks in itself," notes Dr. Kamlot. "Good candidates for minimally invasive procedures include patients who don't want to take lifetime medications and particularly those for whom medications have failed."
"Maze is an FDA-approved procedure that can help identify the origin of atrial fibrillation and treat it surgically," says Dr. Kamlot. "During the minimally invasive Maze procedure, long catheters are inserted via small incisions between the ribs to access the heart while it is beating. Surgeons then eliminate the abnormal conduction pathways on the heart, using ultrasound or cryoablation to freeze tissue, or electrocautery, to treat abnormal tissue with heat."
Minimally Invasive Approach for Valves
Minimally invasive procedures can also be used to repair or replace valves in the heart. "Depending on the degree of malfunction, defective valves in the heart can be life-threatening and may require surgical repair or replacement," explains Dr. Dhillon.
"We perform two main types of valve surgery at John Muir Medical Center—one for the mitral valve, which controls blood flow between the upper and lower chambers of the heart, and the other for the aortic valve, which regulates blood flow from the ventricle, or lower chamber of the heart and aorta. Often we can repair the mitral valve. In other cases, we put in a prosthetic valve (mechanical, metal or made from pig, cow or human pericardium tissue). "When indicated, we typically replace the aortic valve with a prosthetic valve," adds Dr. Dhillon.
Looking Ahead
"At John Muir Health we are developing techniques to access the heart and valves, using smaller incisions—about two inches long versus the six inch incision used in conventional surgery," says Dr. Dhillon. "According to reports in medical literature, these less invasive procedures can be done safely and effectively. And as an added benefit to patients, the results are better cosmetically and the recovery is faster."