- Minimally invasive cardiac surgery
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Minimally Invasive Heart Surgery, also minimally invasive cardiac surgery/coronary artery bypass grafting (MICS CABG pronounced mix cabbage) or The McGinn Technique is heart surgery performed through several small incisions instead of the traditional open-heart surgery that requires a median sternotomy approach. MICS CABG is a beating-heart multi-vessel procedure performed under direct vision through an aterolateral mini-thoracotomy.[1]
Minimally Invasive Heart Surgery is favored by surgeons and patients because of reduced post-operative discomfort, faster healing times and lowered risk of infections or complications. This procedure makes heart surgery possible for patients who were previously considered to be too at risk for traditional surgery due to age or medical history. [2][3]Patients referred for this procedure may have Coronary Artery Disease (CAD); triple Vessel Disease with median to large posterior descending artery (PDA); or previous unsuccessful stenting.
File:ArtValve2.jpgExample of an incision made for MICS CABGContents
The Procedure
MICS CABG is performed through one window incision that stretches 5-7 cm in the 4th intercostal space (ICS). In some cases the thoractomy may be necessary in the 5th ICS instead. A soft tissue refractor is used to allow for greater visibility and access.
Two access incisions are also made at the 6th intercostal space and xphoid process to allow for operative Medtronic(r) instruments to pass through. [4]
Proximal Anastomoses/ McGinn Proximal Technique
The McGinn Proximal Technique is performed with blood pressure lowered to 90-100 systolic which reduces stress to the aorta making it easier to deal with and reducing the risk of damage. A series of tools are used to position and stabilize vessels. The technique uses special tools developed by Medtronic(r) guided through smaller incisions to support surrounding tissues.
Pump-Assisted Beating Heart Bypass
A cannula with a pump and vacuum action is fed up through an artery in the groin to reduce the stress on the heart so that it may still function during the operation. This pump flows at 2-3L per minute to support circulation and eliminates the need for a heart-lung bypass machine.
After Surgery
Using the McGinn Minimally Invasive technique patients recover more quickly than open-heart surgery and suffer less complications. Most patients can expect to resume all everyday activities within a few weeks of their operation. After surgery patients are administered with a pain pump and drains that will be removed after one day. Patients are encouraged to move around as much as possible after their operation to recover quickly.
Once discharged form hospital patients require no further post-operative assistance.ref>"Medtronic", "[6]", 2009</ref>
Minimally invasive heart surgery procedures are a safe and broadly applicable technique for performing a wide range of complex heart procedures, including single or multiple heart valve procedures, bypass surgery, congenital heart repairs.
Minimally invasive heart surgery has been used as an alternative to traditional surgery for the following procedures:
- Mitral Valve Repair and Replacement
- Aortic Valve Replacement
- Atrial Septal Defects
- Coronary Artery Bypass
Benefits of Minimally Invasive Heart Surgery
Eliminating the need for median sternotomy greatly reduces the trauma and pain associated with open-chest surgery and improves quality of life for patients. In the hospital, reduced post-operative discomfort enables patients to more quickly begin a much shorter recovery process with minimally invasive heart surgery. Most patients ambulate more easily and participate more actively in their personal care. Additionally, this approach lowers risk of complications such as bleeding and infection.
Minimally invasive heart surgery dramatically improves cosmetic scarring. Rather than a prominent 10-inch scar down the middle of the chest, patients are left with smaller marks to the side of the ribs. For women in many cases, this scar is completely unnoticeable as it sits below the breast.
Benefits Include:- No splitting of the breastbone
- Dramatic reduction in pain
- Lower risk of infection
- Lower risk of bleeding
- Reduced ICU and hospital stay
- Improved postoperative pulmonary function
- Accelerated recovery/return to activity
- Improved quality of life
- Greatly improved cosmetic result
History
The first minimally invasive heart cardiac surgery was performed in the United States on January 21, 2005 at The Heart Institute at Staten Island University Hospital in Staten Island, New York by a team led by Dr. Joseph McGinn. This technique is an Off-pump coronary artery bypass surgery. The procedure is much less invasive than traditional bypass surgery because it's performed through three small incisions rather than the traditional sternotomy. Since its first procedure, over 600 MICS CABG procedures have been performed at The Heart Institute.[5]
References
- ^ "MICS CABG Technique Overview: Minimally Invasive CABG (MICS CABG) Procedure", "[1]", 2010, p. 1
- ^ "NYU Langone Medical Center", "[2]", December 29, 2009
- ^ "The Heart Institute","[3]", March 25, 2011
- ^ "MICS CABG Technique Overview: Minimally Invasive CABG (MICS CABG) Procedure", "[4]", 2010, p. 1
- ^ "The Heart Institute","[5]", March 25, 2011
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