Minimally Invasive Cardiac Surgery Techniques

In recent years, many new avenues have emerged for treating cardiac valve disease. Conditions such as mitral valve prolapse can be treated through open-heart surgery, minimally invasive surgery, or sometimes without any surgery at all – instead inserting collapsible valves or clips through a small incision in the groin and placing them in the heart with catheters.

Nowadays, when we have so many options, it’s absolutely crucial that patients are seen by both a cardiologist and a heart surgeon who work together to determine the best treatment option for each patient," said Dr. Tobias Deuse, an internationally renowned cardiac surgeon-scientist and is  director of the Minimally Invasive Cardiac Surgery Program.

There are some procedures that cardiologists do, some that surgeons do, and some procedures that we do together because they involve both of our areas of expertise. With modern heart interventions, the line between cardiology and surgery has become less obvious.

UCSF offers the full range of minimally invasive approaches for heart valve repair and replacement and Atrial Septal Defect (ASD) Closure. The benefits are significant including less post-operative pain at the incision site, a shorter hospital stay, a faster return to normal activities, and an improved cosmetic result.

• Minimally Invasive Mitral Valve Surgery
• Minimally Invasive Aortic Valve Surgery
• Minimally Invasive Atrial Septal Defect (ASD) Closure

Advantages of Minimally Invasive Approach

Whereas traditional open surgery usually involves a long incision through the center of the chest, which cuts through the breastbone and requires several weeks to heal, he has significant experience in using smaller incisions. Through these "keyhole" incisions, he inserts long-handled surgical instruments and three-dimensional endoscopes, which allow him to view the surgical site on a video screen as he performs the procedure. These incisions can be made in between the ribs, so no bones need to be cut.

If we can avoid opening up the sternum, patients maintain a fully functioning and stable chest," said Dr. Deuse. "That allows patients – especially those who are frail and elderly – to rehabilitate and mobilize more quickly.

For example, patients recovering from open cardiac procedures should avoid lifting suitcases and other heavier items or using their arms to help them walk for eight weeks, due to the risk of reopening their surgical incision and thereby increasing the chances of wound infection. By contrast, patients who have minimally invasive surgery are allowed to move freely and use their arms as soon as they feel up to it.

Benefits for Obese Patients

Contrary to conventional wisdom, minimally invasive surgery is feasible even in overweight patients.

It’s absolutely true that it’s much harder to do in obese patients," said Dr. Deuse, noting that surgical instruments need to be inserted through a deeper incision to get to such patients’ hearts, and there is less room to maneuver because the internal organs push the patient’s diaphragm higher into the chest cavity.

But very obese patients benefit very much from this approach, because they’re at even higher risk of wound infections and have more difficulty standing up and moving after the procedure due to their weight. Because it can benefit such patients, it’s worth the effort.