Dr Kaushalendra Rathore MCh FRACS
Cardiothoracic Surgeon
JJ group of Cardiothoracic Surgery
Minimally Invasive Cardiac Surgery

Mostly access in the cardiac surgery is limited not only by the complexity of the procedure but also by the cardiopulmonary bypass. But cardiac surgery is moving in the direction of MICS and various procedures are established using smaller incisions

• Off Pump CABG: Bypass grafting without using cardiopulmonary bypass and without stopping the heart is a subgroup which can be called MICS because bypass machine has its own known complications. Further, this surgery can be done with a small incision in the left chest in selected patients (MIDCABG) and can give cosmetic results as well.

• Mitral valve: Mini-mitral surgery is now well-established procedure with more than a decade’s follow-up in various institutes over the globe. Small incision is made on the right side of the chest and another small cut is made in the groin to establish the bypass circuit.

• Aortic valve: This field is evolving with an exciting pace and multiple options are surfacing for example, hemi-sternotomy AVR, RAT-AVR and TAVI. Surgical MICS can be done through partial sternum opening (hemi-AVR) or through an incision in the right side of the chest (RAT-AVR), but both techniques require an incision in the groin to establish cardiopulmonary bypass in majority of the patients. TAVI is a per cutaneous option to replace the valve but offered to the highly selective high-risk patients after a team consensus (cardiologist and surgeons).

• What are the advantages? There are no marked differences in the long-term outcomes, but for sure, recovery and back to the normal life can be achieved earlier in the MICS patients.

• Do MICS have lesser risk of complications? In experienced centres, risk does not change much whether surgeon goes from sternal route or from the ribs, but in the cases of emergency surgeon has to open the chest from sternal route for the patient safety (as I often say: cardiac surgery is not always a cosmetic operation).