Minimally invasive cardiac surgery
medical intervention
Minimally invasive cardiac surgery, encompasses various aspects of cardiac surgical procedures (aortic valve replacement, mitral valve repair, coronary artery bypass surgery, ascending aorta or aortic root surgery) that can be performed with minimally invasive approach either via mini-thoracotomy or mini-sternotomy. MICS CABG (Minimally Invasive Cardiac Surgery/Coronary Artery Bypass Grafting) or the McGinn technique is heart surgery performed through several small incisions instead of the traditional open-heart surgery that requires a median sternotomy approach, and can be performed in patients with multivessel coronary artery disease. MICS CABG is a beating-heart multi-vessel procedure performed under direct vision through an anterolateral mini-thoracotomy.
Advantages of minimally invasive heart surgery are less blood loss, reduced post-operative discomfort, faster postoperative recovery and lower risk of infections, reduced duration of mechanical ventilation as well as eliminating the possibility for sternal non-union. This procedure makes heart surgery possible for patients who were previously considered too high risk for traditional surgery due to age or medical history. Patients referred for this procedure may have coronary artery disease (CAD); aortic, mitral or tricuspid valve diseases; or previous unsuccessful stenting.
A recent meta-analysis of randomized controlled trials by Amin et al (2024) showed that minimally invasive mitral valve surgery (MIMVS) reduced the number of days spent in the hospital and demonstrated a trend towards lower postoperative pain scores, but it did not decrease the risk of all-cause mortality or the number of patients needing blood product transfusions.
The procedure
MICS CABG is performed through one 5–7 cm incision in the 4th intercostal space (ICS). In some cases the thoracotomy may be necessary in the 5th ICS instead. A soft tissue refractor is used to allow for greater visibility and access.
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