What are the benefits and indications for minimally invasive cardiac surgery, such as port-access or robotic-assisted surgery, in patients undergoing cardiac procedures like mitral valve repair or coronary artery bypass grafting?

From the Guidelines

Minimally invasive cardiac surgery (MICS) is recommended for suitable candidates undergoing procedures like mitral valve repair or coronary artery bypass grafting, as it offers significant benefits, including smaller incisions, reduced surgical trauma, less blood loss, and shorter hospital stays compared to traditional sternotomy. These approaches, including port-access and robotic-assisted techniques, are associated with less postoperative pain, faster recovery times, improved cosmetic outcomes, and reduced risk of wound infections 1. Specific indications for MICS include isolated valve procedures (particularly mitral valve repair), single or double-vessel coronary disease, atrial septal defect closures, and cardiac tumor removals. However, not all patients are candidates; those with extensive coronary disease, severe calcification, previous chest surgery, or morbid obesity may require traditional approaches 1.

Benefits of MICS

• Smaller incisions and reduced surgical trauma
• Less blood loss and shorter hospital stays
• Less postoperative pain and faster recovery times
• Improved cosmetic outcomes and reduced risk of wound infections
• Preserves chest wall stability and respiratory mechanics, contributing to improved postoperative pulmonary function and potentially reducing complications like mediastinitis

Technical Aspects of MICS

• Specialized instruments inserted through small ports between the ribs or partial sternotomies
• Robotic systems providing enhanced visualization and precision
• Requires specialized training and potentially longer operative times

Indications and Contraindications

• Indications: isolated valve procedures, single or double-vessel coronary disease, atrial septal defect closures, and cardiac tumor removals
• Contraindications: extensive coronary disease, severe calcification, previous chest surgery, or morbid obesity

The technical aspects of MICS involve specialized instruments and robotic systems, which provide enhanced visualization and precision 1. However, MICS requires specialized training and potentially longer operative times. The overall patient-centered benefits of MICS make it an increasingly important option in modern cardiac surgery, with a focus on improving morbidity, mortality, and quality of life outcomes 1.

From the Research

Benefits of Minimally Invasive Cardiac Surgery

• Decreased blood loss 2
• Shorter hospital length of stay 2, 3
• Improved postoperative pain 2
• Better cosmesis 2
• Earlier postoperative physical recovery 3

Indications for Minimally Invasive Cardiac Surgery

• Mitral valve repair or replacement 4, 5, 6
• Coronary artery bypass grafting (CABG) 4, 3, 5, 6
• Aortic valve replacement 4
• Transcatheter approaches for aortic and mitral valve disease 4
• Multivessel minimally invasive direct coronary artery bypass grafting (MIDCAB) 5, 6
• Totally endoscopic coronary artery bypass graft surgery (CABG) 5, 6

Minimally Invasive Techniques

• Port-access surgery 2
• Robotic-assisted surgery 4, 5, 6
• Totally endoscopic robotic cardiac surgery 5, 6
• Awake off-pump coronary artery bypass grafting 6
• Ultra-minimally invasive cardiac surgery 6