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Video-Assisted and Robotic-Assisted Cardiac Surgery
Mitral Valve Repair and Replacement Using a 3-D camera and da Vinci® robotic instruments, mitral valve surgery is performed through a 4 cm working port in the right chest (without breaking any bones) just below the nipple in males and under the breast in females. Patients undergoing this surgery recuperate faster, return to home and work faster, have less risk of blood transfusion and infection. In addition, the incision scar is cosmetically superior to a sternotomy scar.
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Tom Andrew, Milwaukee, age 58, suffered from mitral valve prolapse and regurgitation. Diagnosed in 1996, Tom lived with mitral valve prolapse and mitral valve regurgitation for a number of years. When severe, mitral valve regurgitation can lead to heart failure and abnormal heart rhythms.
Tom’s condition began to deteriorate about four years ago, and his heart started to enlarge. His mitral valve needed to be repaired or replaced. Because of the complexity of his valve disorder, he was at high risk of valve replacement rather than valve repair. He came to Froedtert & The Medical College of Wisconsin seeking robotic repair of his mitral valve. In November 2008, Dr. Masroor successfully repaired the valve and stopped it from leaking.
“I read about Dr. Masroor in Froedtert Today. I was looking for a second opinion and was hoping I could have minimally invasive surgery, so I called him. My experience was phenomenal. I didn’t want the traditional, foot-long “zipper” in my chest. I have a 2-inch incision on the right side of my chest and was in the hospital for three days. One week later, I was walking 4 miles, and after two weeks, I was able to get back on my exercise bike in the basement. I feel excellent. The surgery exceeded all of my expectations. My recovery time was minimal. It’s a different atmosphere at Froedtert. The people are upbeat and they really care! I have nothing but good things to say about Froedtert and Dr. Masroor.”
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Robotic-assisted Coronary Artery Bypass and Hybrid Revascularization
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A patient is shown after undergoing minimally invasive direct coronary artery bypass surgery. |
One or two arteries can be bypassed without using a sternotomy, using the da Vinci robotic system. In this procedure, the robot is used to harvest the internal mammary artery behind the breast bone. A small 4-5 cm incision is made below the nipple to connect this graft to one or more coronary arteries on the surface of the heart. This is performed on a beating heart, and the patient recovers much more quickly than with a traditional sternotomy incision. This procedure is called robotic MIDCAB (minimally invasive direct coronary artery bypass). If there are more blockages that need to be bypassed, a multi-vessel MIDCAB can be performed using the internal mammary arteries from both sides of the chest.
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Greg Pliss, Muskego, age 69, had a coronary artery that was 95 percent blocked. “I was exhibiting the classic symptoms — shortness of breath and chest tightness in August 2008. My primary care doctor (at the Sunnyslope Health Center) did an EKG and said I had had a mild heart attack. He referred me to Dr. (Michael) Cinquegrani at Froedtert, who evaluated me and then conferred with Dr. Masroor. They determined I was a good candidate for robotic bypass surgery, which was done on Sept. 10.
“I was in the hospital for only four days. I recovered a lot quicker because they didn’t cut the breastbone. I have such a minor scar on my chest. It’s such a remarkable procedure. Dr. Masroor is probably one of the premier surgeons in this country for robotic heart surgery. I have total confidence in him, and would recommend him to anyone who needs this type of surgery. I’m very impressed with Froedtert. The post-op care was unbelievable.”
Typically, patients are driven by their family or friends for their follow-up visit after surgery. Much to everyone’s surprise, Mr. Pliss drove himself exactly one week after surgery for his follow-up visit with Dr. Masroor.
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Selected patients with multiple blocked arteries can undergo a combination of robotic MIDCAB for one or two blockages and stenting of the remaining blockage. This is called hybrid revascularization and requires a close collaboration between the surgeon and the cardiologist. This procedure combines the less invasive benefits of stenting with the long-term success of the MIDCAB procedure.
Surgical Treatment of Atrial FibrillationAtrial fibrillation, the most common rhythm disturbance of the heart, is responsible for up to 40 percent of the strokes in people over age 70. Because the atrium does not contract properly, blood flow inside the heart is slowed down. This can lead to formation of blood clots inside the heart. These clots can dislodge from the heart and travel to the brain (causing stroke), the lower extremities (causing gangrene of the legs) or the bowels (causing gangrene of the bowels).
Medical treatment of this arrhythmia is successful in only one-third of patients. Surgery called the Maze procedure is associated with a greater than 90 percent success rate. A modification of this, called the cryo-Maze procedure, has a similar success rate. Minimally invasive cryo-Maze uses the same 2-inch incision in the right chest as the mitral valve surgery. For people with or without mitral valve disease and atrial fibrillation, this surgery can provide sustained relief from atrial fibrillation without the trauma of a sternotomy.
Re-operative Surgery and Other ProceduresIf a patient has had previous heart surgery and is in need of mitral valve surgery, a less traumatic approach through a right chest incision (described above) is available. Similarly, many coronary bypass operations can be performed a second time from a left chest approach without opening the sternum.
Other procedures that can be performed using a minimally invasive approach are:
- Atrial septal defect (ASD) and patent foramen ovale (PFO) repair
- Combined mitral valve and tricuspid valve surgery
- Biventricular lead placement (for a pacemaker) and aortic valve replacement (mini sternotomy)
- Removing tumors in the heart
Author: Marla Fraunfelder | Medical Reviewer: | Saqib Masroor, MD, MHS, FACC |
Last Review Date: Jan. 13, 2009 |
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