Heart treatments were typically conducted through a sternotomy to gain access to the heart (a wide cut in the chest that splits the breast bone). The large incision not only produces a long, unsightly scar, but it also causes extreme pain, physiological trauma, a protracted hospital stay, and a long recovery time.
Heart surgery techniques and technology have evolved over time, allowing heart surgeons to improve surgical techniques in order to lessen pain and suffering for patients while keeping the surgery’s safety and effectiveness.
In most parts of the world, minimally invasive cardiac surgery (MICS) is well-developed and recognised. The length of the cut for MICS is specified as fewer than 4 inches, according to rigorous requirements.
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Minimally invasive cardiac surgery has been employed in coronary artery bypass surgery (CABG) and cardiac valvular surgery up to this point.
The left internal mammary artery (LIMA), which is the optimum route and affords the best long-term patency for minimally invasive direct coronary artery bypass surgery (MIDCAB), can be harvested in three ways:
- A 6–8cm anterior thoracotomy is performed.
- Thoracoscopy with video assistance (VATS)
- Thoracoscopy with robotic assistance
Each of these approaches has its own set of advantages and disadvantages. Because there is a learning curve, it is critical for the cardiac surgeon to be well-versed in such approaches.
Following the LIMA harvest, the artery will be linked to the most crucial left anterior descending artery, which will provide patients with a better long-term outcome. The patient has a more stable blood flow and less bleeding during the procedure due to the off-pump approach and minimum handling of the heart.
Minimally invasive cardiac surgery is also commonly utilized in isolated cardiac valvular surgery, such as mitral valve repair and replacement, tricuspid valve repair and replacement, and aortic valve replacement. The most typical method is to make a 6–8cm cut in the sternum. It can also be reached by a tiny cut through the chest or robotic-assisted surgery for mitral and tricuspid valve surgery.
These minimally invasive procedures, in the hands of a competent cardiac surgeon, will provide patients less physical and psychological trauma while retaining the surgery’s goal in safety. The patient can usually be discharged from the hospital in 3–4 days after MICS and resume most of their normal activities in 2–4 weeks.
MICS has evolved throughout time and has been effectively used in a variety of cardiac procedures, including atrial septal defect closure, tricuspid valve repair, DOR procedure (chronic heart failure operation), excision of a left ventricular blood clot, arrhythmia surgery, and ventricular septal rupture.
Hybrid Approach
It may be challenging to provide appropriate therapy alternatives for a patient with complex cardiac disease in today’s medical world. Some coronary arteries, particularly the left anterior descending artery, may be better treated with angioplasty and stenting in a patient with ischemic heart disease, whereas others, particularly the left anterior descending artery, may be better treated with a CABG and LIMA attached to it.
In a patient with cardiac valvular disease and coronary artery disease, a full sternotomy will be performed using normal procedures to repair both the valve and the stenosis in the coronary artery.
The hybrid approach to a patient’s cardiac condition can now give a new perspective in treatment planning and work towards the best potential outcome, thanks to the development of minimally invasive cardiac surgery and increased teamwork between cardiologists and cardiac surgeons.
LIMA – LAD anastomosis provides long-term patency and patient survival in patients with multiple coronary artery disease. In terms of clinical outcomes, total arterial coronary artery bypass is frequently appealing. However, this occurs in less than a quarter of all cases.
On the other hand, despite the fact that percutaneous coronary intervention (PCI) with stents is one of the least invasive of all revascularization interventions, and despite the fact that coronary stent technology has advanced dramatically, its outcome still falls short of LIMA – LAD, which has a 20-year patency rate of over 90%.
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