In Conversation with Doctors

 

Keyhole Heart Surgery

by Professor Dr Shahrul Amry Hashim, Consultant Cardiothoracic Surgeon

Introduction

Traditional heart surgery is performed by making a cut made down the sternum, through bone and muscle. This process is called median sternotomy approach to gain access to the heart. The sternotomy incision put a lot of stress and demand to the human body to heal this big fracture. Therefore, it can lead to longer recovery for patients.

Traditional sternotomy

Since year 2012 in UMSC , an alternative approach called Key Hole Heart surgery was introduced, utilizing a tiny incision (5-8cm) on the right or left side of the chest wall working in between the rib spaces to access the valves or coronary artery.  The view to the heart and valve is enhanced and magnified by incorporating a 5-mm or 10-mm telescope and the surgery is guided by this excellent endoscopic view displayed onto a display monitor.

Keyhole mitral valve surgery

 

UMSC team performing keyhole mitral valve repair

Diseases treated with keyhole heart surgery

Nowadays many heart diseases can be treated with keyhole method. In UMSC diseases of the mitral valve, aortic valve, coronary artery and hole in the heart are routinely performed through the keyhole method.

Mitral valve disease

The mitral valve is a cardiac valve that controls blood flow from the left atrium to the left ventricle and the valve functions to ensure that blood flows in a unidirectional forward flow between these chambers of the heart. The mitral valve can be diseased resulting in either a leaking (mitral regurgitation) or narrowed (mitral stenosis) valve. For patients with severe mitral valve disease, the treatment indicated is surgical valve repair (the preferred choice whenever feasible) or valve replacement. Majority of mitral valve diseases now can be treated utilising keyhole method.

Diagram showing valves of the heart including aortic and mitral valve

 

Aortic valve disease

The aortic valve is a cardiac valve that controls blood flow from the left ventricle to the aorta and the valve functions to ensure that blood flows in a unidirectional forward flow between the heart and the human body. The aortic valve can be diseased resulting in either a leaking (aortic regurgitation) or narrowed (aortic stenosis) valve. For patients with severe aortic valve disease, the treatment indicated is surgical valve replacement. Majority of aortic valve diseases now can be treated utilising keyhole method.

Coronary artery disease

Blockages of the coronary artery of the heart can cause one to experience chest discomfort or pain and in worse case scenario causing heart attack that may lead to sudden death.

Depending on the severity of the blockages some patients will need a coronary artery bypass surgery. Utilising keyhole method, one to three coronary arteries can be bypass through small incision. In some cases, keyhole heart surgery is combined with angioplasty/stenting to achieve complete revascularisation.

 

 

 

 

 

 

 

 

Diagram of keyhole coronary artery bypass procedure.

Hole in the heart

Condition such as atrial septal defect can be easily closed with keyhole heart surgery

Benefits of keyhole heart surgery

  • Shorter ventilation time
  • Lower incidence of post-operative atrial fibrillation
  • Reduced transfusion rate and reduced post-operative bleeding
  • Shorter ICU stays
  • Shorter hospitalizations stay
  • Lower risk of complications
  • Improved cosmesis with minimal incisions and scarring, especially for women’s scars that can be hidden in the inframammary crease
  • Eliminates risk of sternal wound complication
  • Less in post-operative pain
  • Faster return to active life

Safety of keyhole heart surgery

Keyhole heart surgery has been performed since late 1990’s. Thousands of patients from all over the world have benefitted from these procedures. As mentioned earlier majority of heart diseases can now be fixed with this method. However, when we are making decision on which way to perform your surgery, safety cannot be compromise. So who is suitable depends many factor such as your age, your health, and how many other procedures your need to fix your heart.

How do I get treatment?

In summary please speak to your doctor or your heart specialist, ask about option of keyhole or minimally invasive surgery to fix your heart. Of course you can get in touch with us in UMSC, where we can advise you on your key hole heart operation with us or we can direct you to specialist who perform them on a regular basis.