|
|||
   |
|||
Minimally Invasive Heart Surgery
Suggested Links:
Heart surgery is one of the major medical advances of the past 30 years. Coronary artery bypass grafting (CABG), and replacement and repair of the aortic and mitral valves are among the most frequently performed heart operations. Each year approximately 350,000 CABG operations are performed in the U.S. About 80 percent involve diseased vessels on front, side and/or back of the heart. Another 70,000 operations are done to replace or repair the mitral or aortic valve. Today, an increasing number of these surgeries are performed using minimally invasive surgical techniques rather than the conventional open-chest surgery.
What Is Minimally Invasive Heart Surgery?
"In general, minimally invasive means minimal intrusion into the body," says Jatinder Dhillon, M.D., cardiothoracic surgeon on staff at John Muir Health. "Currently it refers to procedures for bypassing critically blocked arteries and heart valve replacement that are performed through smaller incisions." In some instances, the surgeon is able to use an advanced cardiac surgery technique called beating heart surgery. In beating heart surgery, cardiac bypass grafting is performed while the patient's heart continues to beat. This allows the surgeon to operate without placing the patient on the cardiopulmonary bypass systems used in conventional cardiac surgeries.
The three coronary bypass techniques that use the minimally invasive approach are Minimally Invasive Direct Coronary Bypass (MIDCAB), Off-Pump Coronary Artery Bypass (OPCAB) and Robotic Assisted Coronary Artery Bypass (RACAB).
The Advantages Of Minimally Invasive Surgery Are Many:
- Fewer complications
- Less bleeding or need for blood transfusion
- Less likelihood of stroke, lung and kidney complications, and problems with mental clarity following surgery
- Shorter hospitalization, usually 3-4 days
- Smaller scar and less pain
- Faster return to usual activities (2-3 weeks)
What is MIDCAB surgery?
MIDCAB is suitable for patients with blockages in the arteries on the front of the heart. Unlike conventional open-heart bypass surgery, which requires a large incision, MIDCAB uses a small 6-10 centimeter incision and is performed only on patients requiring 1-2 bypasses. "This procedure offers the proven benefits of conventional coronary artery bypass surgery, but with a significant reduction in post-operative complications," says Dr. Dhillon.
Opcab Surgery For Multiple Vessel Bypass
The OPCAB procedure is used to perform multiple (4-5) vessel bypass surgery. It is similar to conventional bypass surgery, but does not use the heart-lung machine. Instead, the surgeon, using a stabilizing device to restrict the movement of small segments of the heart, is able to operate while the heart is still beating. The use of this procedure has grown significantly because of its post- operative advantages over conventional CABG.
RACAB—The Latest Advance in Coronary Surgery
"There is a lot of enthusiasm about this new procedure," Dr. Dhillon asserts. "It is the latest advance in coronary surgery. With RACAB, the surgeon uses a robotic device to perform the operation. One of the great advantages over conventional surgery is that the physician is able to perform coronary bypass without separating the breastbone at all."
John Muir Health has acquired the Intuitive Surgical da Vinci Robotic System. It is currently in use for chest, laparoscopic surgery and radical prostatectomy. FDA approval for cardiac surgery is expected soon.
Once cardiac surgery using the da Vinci Robot is approved, we envision using it for heart bypass operations, valve replacements and repairs and for closing of septal defects. "The system has major advantages for patients with minimal scarring, less pain, faster recovery and greatly reduced infections or complications," according to Dr. Dhillon.