Cardiac surgery for various heart diseases can engross vital surgical procedures in order to affect necessary structural repairs. According to top cardiac surgeons, almost 80 percent of psychological & physiological stresses relevant to cardiac surgeries are fundamentally connected to how much invasion is necessary to enter & leave the chest, plus the trauma from additional support methods like cardioplegia & cardiopulmonary bypass (CPB). Minimally invasive surgical strategies that have advanced over the past few years have concentrated on minimizing surgical trauma that a patient has to face, while making lasting & robust surgical repairs. With minimally invasive cardiac surgery techniques, surgeons can perform cardiac surgery in an effective, safer & simpler way. New approaches are being pursued in minimally invasive cardiac surgery, including using smaller or limited incisions to repair only specific regions of the patient’s heart.
What is Minimally Invasive Cardiac Surgery?
Minimally invasive cardiac surgery, also referred to as keyhole surgery is a procedure in which a conventional cardiac operation is executed on or inside the heart using various smaller incisions that measure only about 3 - 4 inches & operation performed with help of specialized instruments. Traditional cardiac surgery generally requires exposure of heart & its vessels by dividing the breastbone of patients (median sternotomy) & which is considered to be most invasive & traumatic aspects of open-chest cardiac surgery. Minimally invasive surgical approach allows easy access to heart without separating the breastbone & ribcage, stopping the heart or requiring a heart-lung machine to be used.
Heart diseases can arise from a variety of factors. Some of the major factors that contribute to serious heart conditions leading to significant heart disease are given below.
In addition to these, genetic factors can also increase risk of developing heart disease in patients.
- High blood pressure or hypertension
- Extreme smoking
- Drug abuse
- Excessive use of alcohol or caffeine
- Elevated cholesterol or triglycerides
- Being physically inactive
- Unhealthy diet
Some other signs & symptoms of severe heart conditions can include the following.
- Breathlessness - This may happen after physical activity or at rest. It may be bad when patients are lying down & they may wake up suddenly at night needing to catch their breath.
- Fatigue - Patients may feel very tired most of the time & find exercise exhausting.
- Swollen Legs & Ankles - This may be caused by a build-up of fluid, it may be better in morning & get worse later in the day.
Some patients with underlying heart disease may also experience feelings of anxiety & extreme depression.
Various types of heart procedures may be performed with minimally invasive heart surgery. Minimally invasive cardiac procedures may include the following.
- Persistent cough, which may be worse at night
- Dizziness & fainting
- Weight gain or weight loss
- Heavy breathing
- Bloated tummy
- Loss of appetite
- Faster heart rate
- Fluttering, pounding or irregular heartbeat
Following types of incisions are commonly used in minimally invasive cardiac surgeries.
- Aortic valve replacement
- Coronary artery bypass surgery
- Mitral valve repair & replacement
- Tricuspid valve repair & replacement
- Atrioventricular septal defect surgery
- Saphenous vein harvest for coronary artery bypass surgery
- Maze procedure for atrial fibrillation
Following tests may be helpful in diagnosing serious heart conditions.
- Partial Sternotomy - This approach involves making a 3 – 4 inch long incision through sternum & separating a breast bone in that region to execute surgery.
- Mini-Thoracotomy - Cardiac surgeons do not make an incision through the breastbone, instead they cut into muscles between ribs to access the heart in mini-thoracotomy.
- Robotically Assisted Cardiac Surgery - Robotically assisted cardiac surgery is done through a small working incision & three additional small incisions that are made between the ribs. Robotic arms are used in this type of approach. Many types of robotically assisted cardiac surgeries are used to treat for the following conditions.
- Mitral valve repair
- Tricuspid valve repair
- Coronary artery bypass surgery
- Ablation of atrial fibrillation
- Atrial septal defect (ASD) repair
- Patent foramen ovale (PFO) repair
- Removal of cardiac tumors
- Coronary Artery Bypass Surgery - This may be performed by using a minimally invasive incision created between the ribs as well as ports. This procedure may be executed on a beating heart without using the heart-lung bypass machine & which is known as off-pump coronary artery bypass surgery (OPCAB).
Following stages describe how severe is the condition of patient’s heart.
- Blood Sample Test - Abnormality in patient’s blood that might be an indication of heart failure or any another illness.
- Electrocardiogram - This test records the electrical activity of patient’s heart to check for heart-related problems.
- Echocardiogram - This is a type of ultrasound scan which uses sound waves to examine the patient’s heart.
- Breathing Test - Patients may be told to blow into a tube to check whether any lung problem is contributing to patient’s breathlessness condition.
- Chest X-Ray - It is done to check whether patient’s heart is larger in size than it should be & whether there is fluid in lungs.
Minimally invasive cardiac surgery confers several advantages over standard techniques derived largely from less trauma to chest wall tissues. Main benefits of minimally invasive cardiac surgery include the following.
- Class I - Patient’s don't have any noticeable symptoms during normal level of physical activity.
- Class II - Patients are comfortable at rest, but strenuous physical activity prompts symptoms.
- Class III - Patients are relaxed at rest, but even slight physical activity triggers symptoms.
- Class IV - Patients are unable to perform even slight amount of physical activity without discomfort & they may have symptoms at any given point of time.
It depends on patient’s condition & what kind of minimally invasive cardiac surgery they are going to undergo. Patients should however be sure to ask surgeons for more detailed guidelines.
- Smaller incisions
- Lower risk of infection
- Lesser blood loss
- Less pain
- Smaller scars
- No splitting of breastbone
- Reduced hospital stay
- Accelerated recovery/return to activity
- Improved postoperative pulmonary function
- Enhanced quality of life
- Smoking - When patients have a habit of smoking, they should talk with the doctor about alternatives for quitting this habit prior to surgery. Smoking before surgery can lead to breathing complications after surgery.
- Medications - Patients should tell doctors about the medications they consume. Surgeons may ask patients not to take certain medicines, like aspirin, that affect blood clotting capacities. Patients should stop taking any medicine strictly when the surgeon tells to for ensuring safety.
- Primary Tests - Few days before cardiac surgery, patients will have to undergo number of diagnostic tests, including an electrocardiogram, chest X-ray or urinalysis.
- Blood - Patient’s blood will be matched & typed with units of donor blood in case they would require a blood transfusion.
- Food Intake - Patients should not eat or drink anything after midnight before cardiac surgery. On the very next day, patients will be admitted to the hospital.
- Pre-Operation Measures - Nurses or hospital staff will give pre-operation medicines to patients & prepare them for surgery. During surgery, patients should avoid wearing any kind of jewelry, contact lenses or dentures.
Minimally invasive cardiac surgery includes thoracoscopic surgery, robot-assisted cardiac surgery or surgery through a small incision made in the chest area. In all kinds of minimally invasive cardiac procedures, cardiac surgeons access patient’s heart through small incisions made between the ribs of the patients’ chest. For several surgeries, patients may be connected with a heart-lung bypass device, which allows blood to circulate through the whole body during the procedure.
- How many of minimally invasive cardiac procedures have you performed?
- How long have been doing these cardiac surgeries?
- What alternative solution exists if minimally invasive cardiac surgery fails?
- Is the team of surgeons comfortable with performing minimally invasive cardiac procedures?
- What steps will be taken for pain relief after surgery?
- As per your knowledge, when are these minimally invasive techniques not appropriate?
- How often will I have to come for follow-up sessions?
- When will I be able to completely recover?
- What measures do I need to take during recovery phase?
- What are the mechanisms involved in follow-up care?
Patients will go to the intensive care unit right after minimally invasive cardiac surgery, where doctors will monitor their condition like they do after standard cardiac surgery. Patients for this purpose will be connected to devices that monitor ECG, heart beat & blood pressure for up to 24 hours post-operation.
Patients will generally spend one day or so in the ICU. Patients will be given fluids, proper nutrition & suitable medications through intravenous lines. After the ICU, patients will be moved to a regular room for 2 - 3 days. Time that patients spend in ICU & hospital can however vary, depending upon the health condition & surgery procedure. Surgeon’s team will monitor patient’s condition & watch for bad signs of infection in incision sites. Surgeons will then check blood pressure of patients along with breathing & heart rate. Surgeons will take appropriate measures to manage pain which patients may experience after minimally invasive cardiac surgery. Cardiac surgeons may instruct patients to walk daily & increase physical activity & to do breathing exercises as they recover. Surgeons also will give instructions to patients during the recovery phase, such as proper caring for incisions, managing pain, taking medications on time & other side-effects following minimally invasive cardiac surgery.
Cardiac surgeons will talk to patients about risks of minimally invasive cardiac surgery. In general, complications of minimally invasive cardiac surgeries are much lower than they are with traditional cardiac surgeries. Some of the major complications are listed below.
- Thoracoscopic Surgery - In thoracoscopic surgery,also known as mini-thoracotomy, cardiac surgeon inserts a thin long tube called as a thoracoscope, consisting a little but high-definition video camera into a small incision in their chest. Cardiac surgeon repairs patient’s heart using sharp &long instruments inserted through anumber of small incisions between their ribs.
- Robot-Assisted Cardiac Surgery - In robot-assisted cardiac surgery, the exact steps performed in conservative open-chest surgery are replicated by cardiac surgeons with help of robotic arms, rather than the surgeon’s hands. During this surgery, cardiac surgeons reach patient’s heart & view through a magnified high-definition 3-dimensional view up on a monitoring screen.
These complications are more likely to happen if patients are obese, have diseases such as diabetes, or have had undergone any bypass surgery in the past. However, they can be minimized by proper care & following guidelines of cardiac surgeons.
After minimally invasive cardiac surgery, patients will have a better & enhanced quality of life along with reduced symptoms. Surgeons will clearly instruct patients regarding daily routine activities & appropriate exercises. Once patients start following these guidelines, they can expect a speedy & smooth recovery. Patients will need to attend regular check-up appointments with the doctor to ensure a good & healthy condition. They may have to undergo various tests to examine & precisely monitor patient’s health conditions. Patients should incorporate healthy lifestyle changes like taking a healthy diet, stress management & quitting tobacco & other such habits for the rest of their life. Patients should follow the schedule given by their cardiac surgeons that are designed to help them improve health & help in healing the body after cardiac surgery.
- Breathing problems
- Blood clots in legs
- Blood loss
- Heart attack
- Infection of lungs
- Urinary tract infection
- Chest infection
- Temporary wound infection
- Heart rhythm problems
- Pain at the site of incision
Medical Tourism in India for Minimally Invasive Cardiac Surgery
India is one of the best & affordable medical tourism destination across the world. Minimally invasive cardiac surgery in India is available at various multispecialty hospitals at affordable costs. Minimally Invasive Cardiac Surgery is the recent approach in trying to move open heart surgeries to the class of minimally invasive surgery so as to reduce the degree of trauma involved in cardiac surgery as far as possible.
Minimally Invasive Cardiac Surgery with Travcure Medical Tourism
When international patients are planning to undergo minimally invasive cardiac surgery in India, then Travcure Medical Tourism is the right healthcare company for them. Travcure is associated with the finest cardiac surgeons & best Indian hospitals in India to offer top-class cardiac surgery to overseas patients. Mortality ratio for minimally invasive cardiac surgery in India including patients with greater risk is at par with the best reputed hospitals in the world. Factors such as lesser cost & range of treatments provided by compassionate healthcare professionals of Travcure differentiate it from other medical tourism companies.