Minimally-invasive procedures

Minimally-invasive cardiac surgery can be less disruptive and traumatic for the human body, reducing recovery time and improving cosmetic results. Minimally-invasive techniques may be suitable for certain procedures involving the heart valves and certain types of routine bypass surgery.

Minimally-invasive cardiac surgery - what does it really mean?

Minimally-invasive means that the degree of invasiveness of the procedure is minimal, which is why this type of surgery is often referred to as keyhole surgery. The terms minimally-invasive and keyhole surgery both became established as part of developments in endoscopic surgery, i.e. surgery that uses special instruments and optical probes, which are introduced into the body using sharp-pointed medical instruments (trocars) and cannulas.

Minimally-invasive cardiac surgery can be less disruptive and traumatic for the human body, making it particularly beneficial in elderly patients who are at an increased risk of surgical complications.

The term "minimally-invasive", when applied to cardiac surgery, generally refers to a variety of techniques aimed at making surgery simpler, quicker and less invasive. A particular focus is placed on avoiding the use of cardiopulmonary bypass (a heart-lung machine), and on reducing the size of the access site in the chest as much as possible. 



The term "minimally-invasive" has almost become a catchphrase, and judging by the information commonly disseminated in magazine articles, radio shows and television programs, one might be tempted into thinking that minimally-invasive treatment options are already widely available for a whole range of heart conditions. This sort of information should be treated with caution, as it almost exclusively refers to very new procedures which are, at best, at the clinical trial stage, and have only been used in a select number of patients. This also means that no long-term results exist, making it impossible for the outcomes of such new procedures to be compared with those of similar yet established treatments.

Purely endoscopy-based (keyhole) procedures, such as those used for gall bladder removal, have not proved viable in the field of cardiac surgery. Similarly, the use of minimally-invasive procedures is very much limited to certain heart conditions.

And, while established treatment methods have been tried and tested thousands of times with clearly-established long-term outcomes, the same cannot be said for many of the newer treatment options.

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What conditions are treated with this type of procedure?

Minimally-invasive procedures can be considered in conjunction with the following conditions:

  • Mitral valve defects - when treating defects that affect the heart valve between the left atrium and the left ventricle, surgeons can gain access to the heart via a small incision in the side of the chest, connecting the patient to a cardiopulmonary bypass (heart-lung) machine via blood vessels in the groin.
  • Aortic valve defects - in some patients with defects affecting the heart valve between the left ventricle and the aorta, surgical access may be possible with only a partial sternotomy (only part of the breastbone is cut).
Narrowing of the aortic valve (aortic valve stenosis) - the aortic valve can be replaced using a catheter-based approach (referred to as TAVI) that involves making an incision (a few centimeters in length) in the side of the chest. This procedure does not require cardiopulmonary bypass (a heart-lung machine).
  • Coronary heart disease - in some cases, bypass surgery can be performed using the "off-pump" technique, i.e. without using cardiopulmonary bypass (a heart-lung machine). In spite of this, most patients still require a sternotomy (cutting of the breastbone) to be performed.
  • Isolated stenosis of the left coronary artery - here, bypass surgery can be performed without the use of cardiopulmonary bypass (a heart-lung machine) or a sternotomy (cutting of the breastbone). The surgeon can gain access by making a small incision below the left nipple.

Minimal-invasive Eingriffe in unserem Haus

At the Brandenburg Heart Center, we offer all minimally-invasive procedures currently established in routine clinical practice. After an initial assessment, we will discuss the options that are available in your case. Instead of pursuing minimally-invasive procedures at all costs, we prefer to focus on likely long-term results and the quality of life that is likely to be achieved with a certain procedure. We will only ever advise patients to choose a minimally-invasive option if we are certain that it is likely to produce the same long-term results as conventional surgery.

The following section provides a brief overview of different minimally-invasive procedures and how these are currently ranked in terms of their potential benefits.

  • Minimally-invasive direct coronary artery bypass (MIDCAB)
  • Off-pump coronary artery bypass (OPCAB)
  • Mini extracorporeal circuit (MECC)
  • Minimally-invasive mitral valve replacement/repair
  • Minimally-invasive aortic valve replacement
  • Hybrid procedures
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Benefits associated with minimally-invasive procedures

  • Reduced level of trauma caused to the body
  • Reduced level of trauma caused to the body
  • Can be used in patients with certain isolated heart valve defects
  • Certain bypass graft procedures do not require cardiopulmonary bypass (a heart-lung machine)
Reduced level of trauma caused to the body

Minimally-invasive procedures usually cause significantly less trauma to patients when compared to conventional heart surgery. In particular older, high-risk patients in whom conventional surgery is contraindicated can often be treated successfully using minimally-invasive procedures.
Physicians tend to use the term "minimally-invasive" to describe a variety of techniques aimed at making surgery simpler, quicker and less invasive. A particular focus is placed on avoiding the use of cardiopulmonary bypass (a heart-lung machine) which, during conventional heart surgery, is used to replace the functions normally executed by the patient's heart and lungs. This allows the heart to be stopped, which makes heart surgery much easier for the surgeon. However, this method also results in the patient's blood coming into prolonged contact with artificial surfaces, something that has been shown to be potentially harmful. Surgery performed without cardiopulmonary bypass can therefore lead to a considerable reduction in these harmful effects, reducing the impact on both the patient's blood and immune system.

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Limitations of minimally-invasive procedures

  • Purely endoscopy-based (keyhole) procedures
  • Not feasible or advisable for the treatment of all types of heart disease
Purely endoscopy-based (keyhole) procedures

Purely endoscopy-based (keyhole) procedures, such as those used for gall bladder removal, have not shown to be viable in the field of cardiac surgery. These procedures have so far proved impractical mainly due to the heart's complex anatomy and the fact that the thoracic cavity is a crowded space to work in. So far, surgeons have only ventured as far as using camera systems, endoscopic light sources and long endoscopic instruments to assist with certain procedures.
Not feasible or advisable for the treatment of all types of heart disease.

Not feasible or advisable for the treatment of all types of heart disease

Not all types of heart disease can be - or should be - treated using minimally-invasive procedures. The benefits of procedures that are simpler, quicker and less invasive must be weighed against the potential of these procedures having an adverse effect on long-term outcomes. It is not usually possible for more complex heart surgery and combined procedures to be performed using minimally-invasive techniques.








 
 
 
Relevant information

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    112
    Our Emergency Department:
    +49 3338-69 45 21

Contact person

  • Univ.-Prof. Dr. med.
    Johannes Albes
    Head of Department of Cardiac Surgery at Brandenburg Heart Center

    PA to the Head of Department Gudrun Gaal
    Immanuel Hospital Bernau Brandenburg Heart Center
    Ladeburger Str. 17
    16321 Bernau bei Berlin
    T +40 3338 694-510
    F +49 3338 694-544
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