CCC 2012: Where We Stand with Minimally Invasive Cardiac Surgery

December 2012

Marc Ruel

Minimally invasive cardiac surgery (MICS) is staking a middle ground between open-heart surgery and catheter-based procedures. Not surprisingly, there are pluses and minuses with each specific procedure, and some are more established than others. All offer the advantages of keeping the heart beating so that patients can avoid heart-lung bypass, faster recovery times and the aesthetic benefit of reduced scarring. A panel chaired by Heart Institute surgeon Dr. Marc Ruel looked at the state of the art.

Dr. Ruel himself spoke on MICS cardiac bypass, an area that he has helped pioneer. Together with its American partners on Staten Island, N.Y., the Heart Institute group has now completed 800 of the MICS procedures are performed through a small incision between the ribs. The program has been highly successful, with 98 per cent survival at two years and almost complete elimination of deep wound infections. The primary challenge to wider adoption remains the degree of technical difficulty.

The Heart Institute’s Dr. Khanh Lam discussed MICS ablation surgery for treating the increasing incidence of atrial fibrillation (AF). Medical therapy is not that effective for treating AF, and catheter ablation often requires two or more procedures to control the condition. The open-heart maze procedure is the gold standard, but MICS radio-frequency ablation is achieving better results than catheter ablation with only a single procedure.

For mitral valve surgery, patients like the MICS option and are requesting it. Outcomes are as good or better than open-heart surgery. Disadvantages include increased risks for aortic dissection and stroke. Though they are not for all patients, the overall conclusion was that MICS procedures will continue to proliferate, competing with the advantages of catheter-based approaches.