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Minimally Invasive CABG Surgery

An Effective and Attractive Alternative

Patients who need surgery and desire a minimally invasive approach now have an option: a CABG procedure performed with minimal incisions – without the traditional sternotomy scar.  The clinical benefits, combined with the cosmetic benefits and increased satisfaction levels, make it a very attractive option for your patients.

What is a MICS CABG procedure?

MICS CABG is an off-pump, multi-vessel CABG procedure in which the anastomoses are performed under direct vision through a lateral mini-thoracotomy (a 5-7cm posterior lateral thoracotomy). The internal mammary artery (IMA) harvest can be performed under direct vision, with video assistance, or robotically. Additionally, to assist in achieving complete revascularization, a hybrid approach or pump-assisted beating heart approach can be employed.

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Potential benefits of MICS CABG

  • Complete revascularization can be achieved 
  • Improved cosmetic outcome & patient satisfaction
  • Reduced hospital length of stay
  • Improved referring physician satisfaction with a surgical procedure
  • Improved clinical outcomes 
  • Lasting effects of a surgical LIMA–LAD anastomosis

Who can benefit from MICS CABG?

  • Patient Selection 
  • Patients who meet the following criteria may benefit from MICS CABG.

Are you eligible?

Coronary Anatomy

  • Left main coronary artery disease (CAD) with normal right coronary artery (RCA)
  • Triple vessel disease with medium to large posterior descending artery (PDA)
  • Complex proximal left sided lesions with or without large branch involvement
  • Previous unsuccessful stenting

Co-Morbidities

  • Patients at high risk for problems with median sternotomy, including but not limited to:
  • Long-term steroid use
  • Severe chronic obstructive pulmonary disease (COPD)
  • Advanced age
  • Need for other major non-cardiac operative procedure
  • Severe deconditioning
  • Arthritis or orthopedic problems

AFTER SURGERY | What to Expect

Recovery

MICS CABG patients commonly have shorter ICU stays than conventional CABG patients and typically leave the hospital earlier than with other CABG procedures. MICS CABG approaches can also potentially lead to shorter hospital stays compared to conventional bypass.  Patients often report being able to get back to normal activities within days, versus weeks.

Once at home, MICS CABG patients have no physical restrictions. This type of recovery adds up to patients who are happy to see you at their follow-up appointments.

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Minimally Invasive Valve Surgery

An Effective and Attractive Alternative

Patients who need surgery and desire a minimally invasive approach now have an option: a valve procedure performed with a minimal incision – without the traditional sternotomy scar. The clinical benefits, combined with the cosmetic benefits and increased satisfaction levels, make it a very attractive option for the patient.

What is a Minimally Invasive Valve procedure?

The minimally invasive AVR and MVR procedures are minimally invasive direct access approaches for the Aortic and Mitral valves. The procedures are performed under direct vision through right sided mini thoracotomies and achieved by creating a 5-7 cm incision in the 2nd or 3rd intercostal space (AVR) or the 4th or 5th intercostal space (MVR).

Potential benefits of MICS Valve Procedures

  • Reduced trauma and pain
  • Decreased blood loss
  • Decreased wound infection
  • Reduced recovery time
  • Better cosmetic results and
    improved patient satisfaction
  • No differences in morbidity and mortality
  • Facilitates redo surgery
  • Avoids sternal wound complications

Applications for MICS Valve Procedures

  • Aortic Valve Disease
  • AVR + CABG (RCA)
  • Mitral Valve Disease
  • Tricuspid Valve Disease
  • Double Valve (AVR/MVR and MVR/TVR)
  • ASD (Secundum or Primum)
  • Atrial Myxoma
  • Concomitant Atrial Fibrillation (MVR + Maze)

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Mini AVR Incision Site

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Mini MVR Incision Site

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Mini AVR/MVR Incision Site

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Aortic Valve Repair/Replacement

Standard heart surgery typically requires exposure of the heart and its vessels through median sternotomy (division of the breast bone), one of the most traumatic aspects of traditional heart-related surgical procedures. Newly developed minimally invasive approaches, on the other hand, now offer access to the heart through small incisions and provide an array of patient and surgeon benefits.

For decades, the standard median sternotomy incision, with its straightforward physical access to and maximal visualization of all cardiovascular structures, has been the incision of choice for virtually every cardiac surgical procedure. More recently, and especially over the past decade, a combination of innovation, technology, and increasing patient demand for less invasive surgical procedures has directly challenged this standard. In response, surgical pioneers have harnessed engineering advances in circulatory systems, medical devices, operative instruments, and multimodality imaging, and have developed a variety of new approaches for use in cardiac surgery.

For many patients, a surgeon may decide that minimally invasive cardiac surgery is appropriate. Unlike conventional surgery, which requires a 10” to 12” incision and the use of a heart-lung machine, new minimally invasive approaches can be performed through a 2” to 3” incision placed between the ribs via the right or left chest and may not require heart-lung assistance.

The minimal incision approach has many applications and can now be applied to most cardiac surgical procedures. These procedures include aortic and mitral valve repair or replacement; tricuspid valve repair or replacement; double valve procedures (AVR/MVR and MVR/TVR); congenital heart defects (ASD); atrial myxoma resection; concomitant atrial fibrillation ablation; and single-vessel and multi-vessel coronary bypass grafting.

mvrepair

What is a MICS Valve procedure?

The minimally invasive AVR and MVR procedures are minimally invasive direct access approaches for the Aortic and Mitral valves. These procedures are performed under direct vision through right-sided mini thoracotomies and achieved by creating a 5 cm incision in the 2nd or 3rd intercostal space (AVR) or the 4th or 5th intercostal space (MVR). In addition, these incisions allow for double valve procedures (AVR/MVR and MVR/TVR), congenital heart defects (ASD), atrial myxoma resection, and concomitant atrial fibrillation ablation.

MICS Valve Surgery Applications & Potential Benefits

Applications for MICS Valve Procedures

  • Aortic Valve Disease
  • AVR + CABG (RCA)
  • Mitral Valve Disease
  • Tricuspid Valve Disease
  • Double Valve (AVR/MVR and MVR/TVR)
  • ASD (Secundum or Primum)
  • Atrial Myxoma
  • Concomitant Atrial Fibrillation (MVR + Maze)

 

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    Potential benefits of MICS Valve Procedures

    • Reduced trauma and pain
    • Decreased blood loss
    • Decreased wound infection
    • Reduced recovery time
    • Better cosmetic results and improved patient satisfaction
    • No differences in morbidity and mortality
    • Facilitates redo surgery
    • Avoids sternal wound complications
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    Mitral Valve Repair/Replacement

    Standard heart surgery typically requires exposure of the heart and its vessels through median sternotomy (division of the breast bone), one of the most traumatic aspects of traditional heart-related surgical procedures. Newly developed minimally invasive approaches, on the other hand, now offer access to the heart through small incisions and provide an array of patient and surgeon benefits.

    For decades, the standard median sternotomy incision, with its straightforward physical access to and maximal visualization of all cardiovascular structures, has been the incision of choice for virtually every cardiac surgical procedure. More recently, and especially over the past decade, a combination of innovation, technology, and increasing patient demand for less invasive surgical procedures has directly challenged this standard. In response, surgical pioneers have harnessed engineering advances in circulatory systems, medical devices, operative instruments, and multimodality imaging, and have developed a variety of new approaches for use in cardiac surgery.

    For many patients, a surgeon may decide that minimally invasive cardiac surgery is appropriate. Unlike conventional surgery, which requires a 10” to 12” incision and the use of a heart-lung machine, new minimally invasive approaches can be performed through a 2” to 3” incision placed between the ribs via the right or left chest and may not require heart-lung assistance.

    The minimal incision approach has many applications and can now be applied to most cardiac surgical procedures. These procedures include aortic and mitral valve repair or replacement; tricuspid valve repair or replacement; double valve procedures (AVR/MVR and MVR/TVR); congenital heart defects (ASD); atrial myxoma resection; concomitant atrial fibrillation ablation; and single-vessel and multi-vessel coronary bypass grafting.

    mvrepair

    What is a MICS Valve procedure?

    The minimally invasive AVR and MVR procedures are minimally invasive direct access approaches for the Aortic and Mitral valves. These procedures are performed under direct vision through right-sided mini thoracotomies and achieved by creating a 5 cm incision in the 2nd or 3rd intercostal space (AVR) or the 4th or 5th intercostal space (MVR). In addition, these incisions allow for double valve procedures (AVR/MVR and MVR/TVR), congenital heart defects (ASD), atrial myxoma resection, and concomitant atrial fibrillation ablation.

    MICS Valve Surgery Applications & Potential Benefits 

    Applications for MICS Valve procedures

    • Aortic Valve Disease
    • AVR + CABG (RCA)
    • Mitral Valve Disease
    • Tricuspid Valve Disease
    • Double Valve (AVR/MVR and MVR/TVR)
    • ASD (Secundum or Primum)
    • Atrial Myxoma
    • Concomitant Atrial Fibrillation (MVR + Maze)

     

      		 mvrepair after

      Potential benefits of MICS Valve procedures

      • Reduced trauma and pain
      • Decreased blood loss
      • Decreased wound infection
      • Reduced recovery time
      • Better cosmetic results and improved patient satisfaction
      • No differences in morbidity and mortality
      • Facilitates redo surgery
      • Avoids sternal wound complications
      Print

      Services

      Minimally Invasive Procedures

      The goal of minimally invasive approaches for treatment of valvular heart disease is to reduce the trauma to the patient, while preserving the quality and safety of conventional surgical approaches. Techniques offered include:

      Below are some of the specialties and services that Dr. Herskowitz can offer.  Click on a specific surgery to view details of the procedures.

      MINIMALLY INVASIVE VALVE SURGERY

      VALVE SURGERY

      • Mitral Valve Repair
      • Aortic Valve Replacement/ Repair
      • Aortic Root Replacement
      • Tricuspid Valve Repair
      • Redo Valvular Surgery

      CORONARY BYPASS SURGERY

      • Coronary Artery Bypass Surgery (CABG)
      • Off-Pump Coronary Bypass Surgery (OPCABG)
      • Redo Coronary Revascularization
      • TransMyocardial Revascularization (TMR)
      • Minimally Invasive CABG Surgery

      VASCULAR SURGERY

      CARDIAC ARRHYTHMIA SURGERY

      • Pacemaker Insertion
      • AICD (Automatic Implantable Cardioverter Defibrillator)
      • MAZE Procedure for Atrial Fibrillation

      MINIMALLY INVASIVE HEART SURGERY

      • Repair of Atrial Septal Defects (Primum and Secundum)
      • Resection of Atrial Tumors (Myxoma)

      AORTIC SURGERY

      • Repair of Ascending Aortic / Aortic Arch / Descending Aortic Thoracic Aneurysms and Dissections

      THORACIC SURGERY

      • Thoracotomy Lung Biopsy
      • Thoracotomy Lung Resections and Pneumonectomy
      • Thoracotom Decortication
      • Spinal Exposure for Orthopedic and Neurologic Procedures
      • Chest Wall Resection and Reconstruction

      MINIMALLY INVASIVE THORACIC SURGERY (Video Assisted- VATS)

      • VATS Lung Biopsy
      • VATS Bullectomy and Pleural Sclerosis
      • VATS Lung Resection and Pneumonectomy
      • VATS Resection of Thoracic Tumors