Surgical & Heart Information

The traditional method cardiothoracic surgeons have used to reached the heart is through a sternotomy (Figure: A). While this approach offers complete access to the heart, the patient must spend more time in recovery as the breastbone must heal. In addition, a heart-lung machine is needed when a sternotomy is used to access the patient's heart. As medical techonolgy has advanced, minimally invasive surgical techniques have been created to allow access to the heart without the use a sternotomy and may not require the use of a heart-lung machine.

A variety of surgical approaches are available within minimally invasive surgery. The most common ones that pertain to cardiothoracic surgery include but not limited to:

Right Minithoracotomy: This approach involves a 2-inch incision between the ribs in the right chest, and minimizes trauma while allowing excellent access to the heart (Figure: B). Operations that are routinely performed through this incision include mitral valve repair/replacement, atrial septal defect repair, tricuspid valve repair, atrial fibrillation surgery, or any combination of these procedures.

Left Minithoracotomy: As with the right minithoracotomy, the left minithoracotomy offers minimally invasive access to the heart for procedures that previously required much lengthier incisions. This technique is employed for minimally invasive off-pump coronary bypass and cardiac resynchronization therapy for heart failure.

Hemisternotomy: A partial incision of the breastbone, a hemisternotomy offers an alternative to a sternotomy or full incision of the breastbone. The smaller incision allows access to the aortic valves for aortic valve replacement surgery, while decreasing the risk of sternal wound complications.

J Mark Morales MD has experience treating many types of congenital and acquired heart problems using minimally invasive techniques. Some conditions that can be successfully treated with minimally invasive surgery include:

Minimally invasive surgery dramatically improves cosmetic results. Rather than an 8 to 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. Furthermore, the benefits of minimally invasive surgery are sometimes the most evident in children. Because this advanced technique does not alter the breastbone and minimizes damage to healthy tissue, children have less post-surgical complications as they grow.

Compared to open-chest surgery, minimally invasive techniques result in: