Minimally Invasive Cardiac Surgery
Overview
Traditionally, cardiac surgery requires exposure of the heart through dividing the breastbone (median sternotomy) and use of the heart lung machine (cardiopulmonary bypass). A minimally invasive approach allows access to the heart without the use of the large breastbone incision and may not require the use of the cardiopulmonary bypass.
NYULMC surgeons have achieved an unmatched, research-based level of experience and skill with minimally invasive heart surgery. The cases performed to date have demonstrated that it is a safe and broadly applicable technique for performing a wide range of complex cardiac procedures with highly reproducible results; achieved angiographically-documented anastomotic patency comparable to open-chest surgery and shown that it is the only minimally invasive approach applicable to performing complete revascularization involving all cardiac surfaces; and enabled us to effectively perform single or multiple valve procedures as well as congenital repairs with minimally invasive techniques. As a result the minimally invasive technique is considered the preferred approach for many of these patients.
NYU Langone Medical Center surgeons have performed more minimally invasive cardiac surgeries than any other hospital in the world. As such, our minimally invasive surgery team has successfully developed unparalleled expertise in the broadest range of complex and demanding clinical cases, including:
- Multi-Vessel Coronary Artery Bypass Grafting (CABG)
- Mitral Valve Repair or Replacement (MVR)
- MVR/Tricuspid Repair
- MVR reoperation MVR/CABG
- Aortic Valve Replacement (AVR)
- AVR reoperation
- Congenital Heart Defect Surgery including:
- Atrial Septal Defect (ASD)
- Ventricular Septal Defect (VSD)
- Tetralogy of Fallot
Benefits of Minimally Invasive Heart Surgery
• Dramatic reduction in pain
• Accelerated recovery/return to walking and activity
• Reduced ICU and hospital stay
• Improved postoperative pulmonary function
• Improved quality of life
• Reduced need for inpatient cardiac rehabilitation
• Greatly improved cosmetic results
Eliminating the need for median sternotomy, (an incision through the midline of the sternum to gain access to the heart), greatly reduces the trauma and pain associated with open-chest surgery and improves quality of life for patients. In the hospital, reduced post-operative discomfort enables patients to more quickly begin a much shorter recovery process. Most patients ambulate more easily and participate more actively in their personal care. Currently, NYULMC patients are comfortably managed on a four-day care map. Additionally, this approach lowers risk of complications such as bleeding and infection. Upon returning home, many patients resume their normal lives in much less time after minimally invasive cardiac surgery. They require minimal assistance and report needing little or no pain medication. Often, they begin cardiac rehabilitation sooner and consistently maintain their regimen. In as little as two weeks, patients have resumed day-to-day activities and even returned to their jobs.
Minimally invasive cardiac surgery dramatically improves cosmetic results. Rather than a 10-inch scar down the middle of the chest, the new surgery results in a substantially smaller, less visible keyhole incision on the side of the chest. For many women, the scar is almost unnoticeable as it may be underneath the breast.
NYU Approach
At NYU, the thoracotomy approach has become the standard for minimally invasive heart surgery. Instead of the standard incision through the sternum (breast bone), a small incision is made on the right or the left side of the patient’s chest. The incision length is 3-5 inches and location depends on what surgery is done.
The NYU Department of Cardiothoracic Surgery began research in less invasive forms of cardiac surgery in 1994 and introduced the Port Access approach for mitral valve surgery in an FDA sponsored trial in 1996. Since that time the use of minimally invasive heart surgery has expanded dramatically, and NYU surgeons now have experience in over 4,000 patients using these techniques.
Results have been exceedingly good, with an extremely low operative risk, less bleeding, less risk of infection, and shorter overall recovery. Follow-up studies have shown that valve repair durability is equivalent to that achieved with conventional surgery. Thus, the short term risks are reduced, with equivalent long term results.
In summary, the large and extremely favorable NYU experience with minimally invasive heart surgery suggests that this form of less traumatic surgery is now preferred for most patients requiring aortic or mitral valve surgery, for ASD repair and for atrial myxoma excision. Patients requiring coronary artery bypass are risk stratified using either conventional surgery, MIDCAB or OPCAB, which has lowered the overall risk significantly. Patients having minimally invasive heart surgery require less blood, have fewer infections and recover more quickly. These emerging new technologies are having a dramatic impact on patient care, lowering the overall morbidity, pain and suffering associated with heart surgery in the year 2007.
Cardiac Surgery
NYU Langone Medical Center
530 First Avenue, Suite 9V
New York, NY 10016
(212) 263-2190
Aubrey C. Galloway, M.D.
Seymour Cohn Professor and Chairman / Department of Cardiothoracic Surgery / Director, Thoracic Surgery Residency Program
Gregory Crooke, M.D.
Assistant Professor of Cardiothoracic Surgery / Director, Ventricular Assist Device Program
Alfred T. Culliford, M.D.
Professor of Cardiothoracic Surgery
Juan B. Grau, M.D.
Director, Minority Outreach Program for Prevention of Healthcare Disparities / Director, Undergraduate Medical Education
Eugene A. Grossi, M.D.
Director, Cardiac Surgical Research / Chief, Cardiothoracic Surgery, Manhattan Veterans Hospital
David B. Meyer, M.D.
Director, Pediatric and Congenital Cardiac Surgery Program
Associate Director, Thoracic Surgery Residency Program / Director, Surgical Heart Failure Program / Chief, Cardiothoracic Surgery, Bellevue Hospital Center
Director, Thoracic Aortic Stent Graft Program
