Surgery is commonly required to treat certain cardiothoracic (heart, lungs, esophagus) conditions when medication and catheter-based treatments cannot relieve symptoms. These conditions, include but not limited to mitral valve prolapse, atrial septal defect and coronary artery disease.

Mitral valve prolapse is when one or both of the flaps that are supposed to open and close to control blood flow to the heart do not work properly and allows small amounts of blood to flow backwards into the heart valve. Atrial septal defect is a defect between the left and right chambers of the heart that is congenital – you are born the condition. And, coronary artery disease occurs when arteries that supply blood to the heart become hard and narrow because cholesterol and plaque build-up in the inner walls of the arteries.

Facing traditional cardiac surgery or open surgery to treat disorders in the chest cavity can be a frightening experience. It may be difficult to focus on next steps but you may have several choices to make,such as which hospital and surgeon to go to, and which procedure to choose. Learning as much as possible about your options, including minimally invasive alternatives to open surgery may ease some of your concerns.

Surgery is generally the most effective way to treat disorders of the heart, lungs and esophagus. But traditional open surgery has a number of drawbacks caused primarily by the large incision required, splitting the breastbone and spreading the ribs to access the chest cavity. In addition to an 8 to 10” scar down the center of your chest, splitting of the breastbone leads to a long recovery time of eight to twelve weeks as well as a long delay before you will return to normal daily activities.

Fortunately, less invasive options are available for patients facing cardiothoracic surgery. Many cardiothoracic surgeons now recognize the benefits of small incisions made between the ribs to perform coronary bypass or make repairs to the heart or esophagus by using thoracoscopy – the insertion of a miniaturized video camera between the ribs. But this approach has limitations and is not often appropriate for more complex cardiac procedures.

The da Vinci ® Surgical System provides surgeons and patients with what may be the most effective, least invasive treatment option for even the most complex cardiothoracic procedures. Among the potential benefits of da Vinci ® cardiothoracic surgery are:

  • Shorter hospital stay2
  • Less pain and scarring1
  • Less risk of infection1
  • Less blood loss and need for blood transfusions2
  • Faster recovery1
  • Quicker return to normal activities1

da Vinci® Surgery is a breakthrough surgical system that enables surgeons to operate with unmatched precision, 3D-high definition vision and superior control. By overcoming the limitations of traditional open surgery, da Vinci is revolutionizing cardiothoracic surgery.

As with any surgery, these benefits cannot be guaranteed, as surgery is patient-and procedure specific.

1. “How is Coronary Artery Disease Treated?” National Institutes of Health, www.nhlbi.nih.gov , URL: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_Treatments.html
2. Poston RS, Tran R, Collins M, Reynolds M, Connerney I, Reicher B, Zimrin D, Griffith BP, Bartlett ST. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 2008 Oct;248(4):638-46.

Surgical Treatment Options

Your doctor may recommend a surgical procedure to treat severe CAD, ease your symptoms and reduce your risk of a heart attack. Both angioplasty and bypass surgery are used as treatments.

Angioplasty – Angioplasty opens blocked or narrowed coronary arteries. During surgery, a thin tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. This widens the artery and restores the flow of blood. Angioplasty can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack. Sometimes a small mesh tube called a stent is placed in the artery to keep it open after the procedure.

Bypass surgery – This type of surgery is often referred to as CABG (coronary artery bypass graft surgery) and is also known as coronary revascularization. The goal is to improve blood flow to your heart, relieve chest pain and possibly prevent a heart attack. In traditional bypass, surgeons access the heart by making an 8- to 10-inch incision down the chest, cutting through the breastbone (the sternum) and opening the ribs. This is known as a sternotomy. Surgeons then take a segment of a healthy, plaque-free blood vessel from another part of your body (chest, leg or arm) and attach one end of that vessel to a healthy artery and the other end to the diseased coronary artery below the clogged area. This creates a new channel, allowing blood to flow freely to your heart again.

A pump oxygenator (heart-lung machine) is used for most coronary bypass operations. It takes over the function of the heart and lungs during surgery. Recently, more surgeons are performing off-pump coronary artery bypass surgery, where the heart continues beating while the bypass graft is sewn in place. In many patients, an off-pump approach may reduce serious complications during or after surgery.

Following surgery, patients usually stay in the hospital four to six days. Patients are often enrolled in a cardiac rehabilitation program to learn about stress management, diet and exercise.

da Vinci Surgery for CAD

If you have been told you need bypass surgery, ask your doctor about da Vinci Surgery for coronary artery disease. This procedure is performed without the need for a heart-lung machine, minimally invasively through small incisions made between the ribs. This avoids the need for a sternotomy, its associated risks and complications. da Vinci Coronary Revascularization can also offer several potential benefits over open heart surgery, including:

  • Shorter hospital stay
  • Less pain and scarring 2
  • Less risk of infection2
  • Less blood loss and need for blood transfusions 3
  • Faster recovery2
  • Quicker return to normal activities2

da Vinci Surgery is a breakthrough surgical system that enables surgeons to operate with unmatched precision, 3D-high definition vision and superior control. By overcoming the limitations of traditional open surgery, da Vinci is revolutionizing cardiothoracic surgery.

As with any surgery, these benefits cannot be guaranteed, as surgery is patient-and procedure specific.

1. “What to Expect During Coronary Artery Bypass Grafting”, National Institutes of Health, www.nhlbi,nih.gov , URL: http://www.nhlbi.nih.gov/health/dci/Diseases/cabg/cabg_during.html
2. “How is Coronary Artery Disease Treated?” National Institutes of Health, www.nhlbi.nih.gov , URL: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_Treatments.html
3. Poston RS, Tran R, Collins M, Reynolds M, Connerney I, Reicher B, Zimrin D, Griffith BP, Bartlett ST. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 2008 Oct;248(4):638-46.

Open Surgery for Heart Conditions

Millions of Americans suffer from various types of heart disease, disorders and defects such as coronary artery disease, mitral valve prolapse, atrial septal defect or atrial fibrillation. Many of these heart patients will need surgery to correct the condition if their doctor has determined it is severe.

Regardless of the specific condition, there are certain aspects of traditional or open heart surgery that are consistent, such as a sternotomy. To gain direct access to the heart inside the chest cavity, surgeons must first perform a sternotomy. This involves making an 8- to 10-inch incision down the chest, cutting open the breastbone (the sternum) and spreading open the ribs. Sternotomy can increase: hospital stay, risk of infection, blood loss and need for transfusions, scarring, and pain.

Certain open heart operations also require that a heart-lung machine (pump oxygenator) be used to take over the functions of the heart and lungs during surgery. The heart-lung machine is typically used during surgery on coronary artery disease patients but r ecently, more surgeons are performing off-pump coronary artery bypass surgery, where the heart continues beating on its own during surgery. In many patients, an off-pump approach may reduce serious complications during or after surgery.

Minimally Invasive Cardiac Surgery

Standard heart surgery typically requires exposure of the heart and its vessels through median sternotomy (dividing the breastbone), considered one of the most invasive and traumatic aspects of open-chest surgery.

A minimally invasive approach to heart surgery allows access to the heart through small incisions and without stopping the heart, separating the breastbone (sternum) and ribcage, or requiring a heart-lung machine to be used.

Many cardiothoracic surgeons now recognize the benefits of small incisions made between the ribs to perform coronary bypass or make repairs to the heart or esophagus by using thoracoscopy – the insertion of a miniaturized video camera between the ribs.

Minimally invasive heart surgery is performed through a small incision, often using specialized surgical instruments including a thoracoscope. The incision used in minimally invasive cardiac surgery may be about 2 to 4 inches, made between the ribs, instead of the 6- to 8-inch incision through the sternum (breastbone) required for traditional surgery. 1

Because it relies on traditional minimally invasive surgical technology, this approach has limitations and is not often appropriate for more complex cardiac procedures.

The least invasive approach to cardiac surgery, the “keyhole” approach or port-access technique used in da Vinci Surgery, is available for some types of cardiac and thoracic procedures like mitral valve repair and coronary artery bypass.

Benefits of Minimally Invasive Heart Surgery

The potential benefits of all types of minimally invasive heart surgery may include:

  • A smaller incision
  • A smaller scar

Other possible benefits of a minimally invasive heart surgery may include:

  • Reduced risk of infection
  • Less bleeding with minimally invasive heart surgery
  • Less pain and trauma
  • Decreased length of stay in the hospital after the procedure: Hospital stay may be as little as 3 to 5 days after minimally invasive surgery, while the hospital stay after traditional heart surgery may be 5 days or longer
  • Decreased recovery time: Recovery time after minimally invasive heart surgery may be 2 to 4 weeks, while the recovery time after traditional heart surgery may be 6 to 8 weeks or more.

Types of minimally invasive cardiovascular surgeries include:

  • Valve surgery (e.g. mitral valve repair)
  • Coronary artery bypass graft (CABG) surgery
  • Epicardial lead placement: placement of leads for biventricular pacemakers (cardiac resynchronization therapy)
  • Atrial fibrillation

1. http://my.clevelandclinic.org/heart/disorders/mini_invasivehs.aspx

Treatment Comparisons

Millions of Americans suffer from various types of heart disease, disorders and defects such as coronary artery disease, mitral valve prolapse, atrial septal defect or atrial fibrillation. Many of these heart patients will need surgery to correct the condition if their doctor has determined it is severe.

Regardless of the specific condition, there are certain aspects of traditional or open heart surgery that are consistent, such as a sternotomy. To gain direct access to the heart inside the chest cavity, surgeons must first perform a sternotomy. This involves making an 8- to 10-inch incision down the chest, cutting open the breastbone (the sternum) and spreading the ribs. Sternotomy can increase: hospital stay, risk of infection, blood loss and need for transfusions, scarring, and pain.

Certain open heart operations also require that a heart-lung machine (pump oxygenator) be used to take over the functions of the heart and lungs during surgery. The heart-lung machine is typically used during surgery on coronary artery disease patients but r ecently, more surgeons are performing off-pump coronary artery bypass surgery, where the heart continues beating on its own during surgery. In many patients, an off-pump approach may reduce serious complications during or after surgery.

There are other approaches to heart surgery that are less or minimally invasive that avoid the need for a sternotomy, such as a mini-thoracotomy. With this procedure, surgeons reach the heart through a smaller incision between the ribs, often just a few inches long. They use special instruments as well as cameras to reach and operate on the heart through the smaller opening.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.