Minimally Invasive Cardiac Surgery (MICS) – Procedure, Risks and Preparation

Minimally invasive heart surgery entails making small incisions in the right side of the chest to reach the heart between the ribs. Multiple cardiac conditions can be treated using minimally invasive heart surgery. For many patients, this form of surgery results in less pain and a faster recovery than open-heart surgery.

What is Minimally Invasive Cardiac Surgery?

Minimally invasive cardiac surgery, also known as MICS, is an advanced form of heart bypass surgery to treat coronary heart diseases. Through this technique, the heart is accessed by the surgeon through the side of the left chest via a small incision, often made using specialized surgical instruments. The heart is accessed through the openings between the ribs without cutting. This approach is less invasive compared with traditional open-heart surgery, in which the surgeon is required to open the chest cavity to access the heart.

What are the types of MICS?

There are three types of MICS. They include:

Minimally Invasive CABG Surgery: Unlike the CABG procedure where your chest is fully opened to perform surgery, MIDCABG or Minimally invasive direct Coronary Artery Bypass Graft surgery involves small cuts, generally made under the left breast area
Minimally Invasive Valve Surgery: Valve surgeries including valve repairs and valve replacements in the heart, are the most frequently used minimally invasive surgery
Beating Heart Bypass Surgery: Heart surgery performed while the heart is still beating

Why is the procedure done?

The potential benefits of MICS or Minimally Invasive Cardiac Surgery, when compared with open-heart surgery, may include:

No cutting of bones to open up the chest
Less pain
Decreased blood loss
Faster recovery
Lower risk of complications
Minimal scarring
Shorter hospital stay

Who can be benefited?

Not all can be a candidate for Minimally Invasive Cardiac Surgery or Robotic Cardiac Surgery. Your heart specialist and the treatment team will work with you to determine if it is the right choice for you. Your heart specialist may review your family history, conduct some physical examination and perform some tests to determine if you are candidate for MICS.

How to prepare for Minimally Invasive Cardiac Surgery?

Before Robotic Cardiac Surgery or MICS, your heart specialist and the treatment team may explain to you about potential risks of the surgery and what to expect before, during and after the surgery. They will discuss the concerns you may have about your surgery. You may have to shave the hair at the areas of the body where the procedure may take place. A special soap might also be used to wash your skin to reduce the risk of infection. Before you get admitted to the hospital for the surgery, speak with your immediate family members about your hospital stay to discuss help you may need when you return home. Your heart specialist and treating team will provide you all the instructions to follow during your recovery after returning home.

The following recommendations are given by the doctor:

Food and medications

Consult the doctor about the following topics:

When and whether one can take regular meds before surgery.
When should one stop eating and drinking the night before the surgery.

Clothing and personal items

The medical team may advise to bring the following items to the hospital:

A list of the prescription drugs
Dentures, hearing aids, or eyeglasses
Brushes, combs, shaving equipment, and toothbrushes are examples of personal care goods.
Clothing that is loose-fitting and comfy
Items like a small music player or books that might help relax

Precautions – Medications and allergies

Consult the doctor about the following topics:

Medications one has brought with them to the hospital, as well as when they should take them on the day of the operation
Allergies or adverse drug responses they have had in the past

What can you expect during and after the Minimally Invasive Cardiac Surgery procedure?

During the MICS Procedure

Minimally invasive Cardiac Surgery may include thoracoscopic surgery, robot-assisted heart surgery and surgery through a small keyhole cut in the chest (direct minimal invasive access heart surgery). In all types of less invasive procedures, the surgeons access your heart through small cuts between the ribs of the chest. A tool attached with a small video camera is inserted through one of the keyhole cuts which will help the surgeon to see inside your body. In most of the minimally invasive procedures a heart-lung bypass machine used, as is used in an open-heart surgery. The machine helps in blood moving through the body during the procedure.

Robotic Cardiac Surgery

In robotic cardiac surgery, the surgeon makes use of robotic arms, rather than his/her hands, to perform the surgery and does the exact maneuvers that is used in traditional open-heart surgery. During robotic cardiac surgery, your surgeon works from a remote console and views your heart in a magnified, high-definition (HD), 3-Dimentional (3D) view on a video monitor. From the console, the hand movements of your surgeon translate precisely to the robotic arms present at the operating table, which moves similarly to our wrist. A second heart surgeon and a surgical team assist at the operating table, changing the instruments attached to the robotic arms.

Thoracoscopic surgery

In this surgery (also called minithoracotomy), the surgeon inserts a thin, long tube (thoracoscope) having a tiny HD video camera into a keyhole incision in your chest. The surgeon repairs your heart using long instruments inserted through small keyhole incisions between your ribs.

After the MICS procedure

Usually, you will spend a day in the ICU (intensive care unit). fluids and medications will be administered through intravenous (IV) lines. Other tubes placed during surgery will help drain urine from the bladder as well as fluid and blood from the chest. You may be given oxygen through prongs in your nose or a facemask. After the ICU, you may be moved to a regular hospital room for 3-4 days. Time spent in the ICU and the hospital will solely depend on your condition and the surgery. The treatment team may:

Monitor your condition and lookout for signs of infection at the incision sites
Monitor breathing, blood pressure and heart rate
Help you manage pain
Help you get you and walk and provide instructions to enhance your activity gradually
Show you how to perform deep-breathing exercises and instruct you to cough to keep the lungs clear

What are the results of minimally invasive cardiac surgery?

Aortic stenosis symptoms can be relieved and your quality of life can be improved with minimally invasive heart surgery. To keep track of your heart condition, you’ll need to see a doctor on a frequent basis. Your heart’s health may be assessed through tests. Your doctor may also advise you to live a heart-healthy lifestyle, which includes eating a balanced diet, exercising regularly, managing stress, and not smoking. A tailored program of education and exercise to promote health after heart surgery is sometimes recommended (cardiac rehabilitation).

Conclusion

You may experience fewer symptoms and a higher quality of life after minimally invasive cardiac surgery. When you’re ready, your treating doctor will let you know when you can resume normal activities like driving, working, and exercising. It’s possible that you’ll need to see your treating doctor on a regular basis. You may also be subjected to a series of tests in order to assess and monitor your condition.

FAQs

Can bypass surgery be done without opening the chest?

Surgeons use tiny chest incisions to access your heart through gaps between the ribs during minimally invasive heart surgery. Traditional open-heart surgery, in which surgeons open the chest to access the heart, is more intrusive.

How long does minimally invasive heart surgery take?

The procedure takes about two hours to be completed. Most patients stay in the hospital as many as 10 days after the treatment. Some doctors perform this surgery with a surgical robot, but it necessitates numerous small incisions and takes longer.