Surgery

Minimally Invasive Heart Surgery: Frequently Asked Questions

First Published: March 2000
Last Revised: March 2000
Peer Review Status: Internally Peer Reviewed

How dangerous is heart surgery?

The risks associated with heart surgery need to be individualized. In an otherwise healthy person with normal heart function, a mortality risk of 3 percent can be expected.

What makes a surgery "minimally invasive"?

Cardiac surgery would be considered minimally invasive by two means. The first of these would be the incision being limited in its extent. The second major category would be without the use of cardiopulmonary bypass.

Is minimally invasive surgery possible for removal of a sub-aortic stenosis?

The incision can be minimalized without requiring a full sternotomy thus making it minimally invasive; however, it would still require cardiopulmonary bypass.

What are the advantages of minimally invasive surgery? Is it less stressful on the body? Is there less recovery time?

Preliminary studies show that minimally invasive surgery is associated with a shorter hospital stay and possibly a quicker return to normal function. There appears to be no difference in other factors such as associated complications and mortality.

Who is an ideal candidate for bypass surgery?

Coronary artery disease is treated in three main ways: one is medical therapy; second is percutaneous intervention for angioplasty; and the third is coronary artery bypass graft. Bypass surgery is traditionally recommended for patients with symptoms despite medical therapy and/or with severe three vessel coronary disease (that is, involving all major arteries supplying the heart). It also has improved survival for patients with impaired ventricular function.

What are the disadvantages of minimally invasive surgery?

Being a new technology, there may be an associated learning curve with the physician performing the case. This has only been in use for several years, in contrast to traditional cardiopulmonary bypass which has been done for several decades.

Will all heart surgeries become minimally invasive in the future?

There may be a trend to perform more cases with minimally invasive techniques, but there will always be certain cases that will require traditional cardiopulmonary bypass.

When getting my Blood Pressure checked, it read my left arm has little or no reading...the right arm does register...Could this be a blocked artery?

Yes it could be, but it would require further testing before any definitive diagnosis can be made.

Do you need to have special training to perform minimally invasive surgery?

Currently no. There have been several recent articles trying to identify how to train young surgeons in residency to perform these techniques.

Is bypass surgery considered minimally invasive?

Only if it performed without the use of cardiopulmonary bypass or if it is performed without a full sternotomy incision.

What determines if a patient should undergo bypass or angioplasty?

Basically the extent and location of the coronary artery disease. Bypass surgery is traditionally indicated for patients with left main coronary artery disease, three vessel coronary artery disease, or coronary artery disease with impaired ventricular function. Angioplasty may be used in other circumstances.

Can you give us some general information on what types of problems minimally invasive surgery is used to treat?

Minimally invasive techniques may be used to perform bypass surgery, valvular surgery, and miscellaneous cardiac procedures.

I've read that some heart valves are grown in labs. How do these differ from artificial valves?

There are two main types of heart valves. One is a mechanical valve; the other is a tissue valve. Traditionally, tissue valves are either from cadavers or porcine (pigs). The heart valves grown in labs are just another option of a tissue valve without requiring harvesting from cadavers or other means.

I apologize. I asked this question before but I was unable to get your response: Is minimally invasive surgery an option for removal of a sub-aortic stenosis?

The incision can be minimalized without requiring a full sternotomy thus making it minimally invasive; however, it would still require cardiopulmonary bypass.

How long is the hospital stay for min. invasive surgery as compared to regular surgery?

Being a new technology, the data is not entirely clear in this regard. However, a recent publication has compared a hospital stay off-pump coronary bypass grafting to traditional coronary bypass grafting. The off-pump group was discharged on an average of 3 1/2 days postoperatively compared to an average of 5 days postoperative for traditional bypass.

Is it true that death rates are high when it comes to heart surgery because of re-clotting?

Graft patency is comparable between off pump coronary bypass grafting and traditional coronary bypass grafting.

I have a strong family for heart attacks. Is there anything I can do or tests that I should take to prevent a heart attack?

Depending upon one's age, a yearly physical and a close monitoring of blood pressure and control of serum lipids is advised. Upon approaching one's mid-30's, a cardiology evaluation is indicated for one with a strong family history.

Is it safe to exercise after bypass surgery?

Yes. Exercise is an important component of recovery following bypass surgery. Exercise performed is altered according to the postoperative condition and is best done in a formal cardiac rehab program.

What are the mortality rates after undergoing triple bypass surgery? What can be done post-op for better success rate?

All mortality rates can be altered according to the patient's risk profile. A routine triple bypass operation may be able to be performed with a mortality of less than 3 percent. Early ambulation, good pulmonary hygiene, control of blood pressure, control of heart rhythm: all these modify one's risk profile.

How do I know if I am a candidate for a minimally invasive procedure?

The main determining factor are coronary anatomy and the overall heart function.

I understand an incision can be made underneath the breast for some valvular surgery. Is this considered minimally invasive?

No, thatŐs simply another approach to valvular surgery.

What is nitro glycerin? What does it do?

It is a vasodilator. It works by dilating the blood vessels of the heart to improve blood flow. Thus, it relieves the symptoms of angina.

Is there a lot of blood loss in open-heart surgery? What about bypass surgery?

Blood is conserved during open-heart bypass surgery by aspirating shed blood and re-circulating it back into the patient.

Is nitroglycerin prescribed after heart surgery?

Occasionally. Nitrates may be used postoperative for patients with incomplete revascularization or to prevent graft spasm.

What questions should I ask my surgeon to see if my sub-aortic stenosis can be handled with minimally invasive procedures?

A generic question you may ask is: Have you performed this operation as a minimally invasive technique? This would be the main question. And, would he/she feel comfortable using those means?

Is it normal for people to undergo more than one bypass surgery?

Yes. Vein grafts have been traditionally used for bypass surgery have a ten year patency of 50 percent. Therefore, we do repeat operations on some patients.

What are the symptoms of heart disease?

There can be a multitude of symptoms from heart disease, either from coronary artery blockage or heart valvular disease. These can include such symptoms as chest pain, jaw pain, arm pain, shortness of breath upon exertion, as well as many others. This should be discussed with your doctor to further evaluate.

What is a vein graft?

A vein graft is bypass tubing from a vein, usually harvested from the legs.

How old is the typical bypass patient?

There is an increased prevalence of coronary artery disease with age; however, the spectrum can range from patients in their 30's to their 90's.

What kind of follow up does a patient need after bypass surgery?

Traditionally on discharge from the hospital, follow-up appointment will be made with their surgeon in a few weeks. If all is well, their cardiologist or primary physician will handle further follow-up on at least a yearly basis.

Are certain medical centers more on board with minimally invasive techniques than others?

Yes. There are certain centers which show special interest in minimally invasive techniques.

What is heart catheterization?

It is a procedure that delineates the coronary arteries by taking x-ray pictures while a contrast agent is placed within the coronary arteries.

Do you recommend dietary changes to your patients after bypass surgery?

Absolutely. All risk factors of coronary artery disease are monitored postoperatively. These include serum lipids, blood pressure, heart rate, not smoking, and daily aspirin. Diet is a big component of lipid management.

So aspirin is recommended for heart health?

Aspirin is used in patients undergoing cardiopulmonary bypass as it has been shown to improve early graft patency.

How long does the actual surgery take?

For a routine bypass operation, approximately four hours.

How long is the hospital stay?

For routine bypass operations, three to five days.

Do you perform open-heart surgery on Down syndrome patients?

Yes, I perform open-heart surgery. However, I perform adult cases and not congenital heart procedures, which may be associated with Down syndrome.

What does minimally invasive mean, in lay terms?

1. The extent of the incision. 2. Bypass without the use of cardiopulmonary bypass.

Is there anyone that you would not perform bypass surgery on?

Yes, patients without viable heart muscle and patients without anatomically acceptable target arteries.

See related Patient Topics Angioplasty, Heart and Circulation, Heart Bypass Surgery, Procedures and Therapies or Surgeries.

See related Provider Topics Heart and Circulation, Procedures and Therapies or Surgeries.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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