Minimally invasive heart surgery

Minimally invasive heart surgery, sometimes referred to as keyhole heart surgery, refers to surgical procedures performed through one or more small incisions in the chest. During minimally invasive cardiac procedures, surgeons guide small cameras, robotic instruments, and other surgical tools through the incisions and between the ribs to access the heart.

There are two types of minimally invasive heart procedures:

• Robotic-assisted surgery: Your surgeon will guide robotic arms through one or more small incisions in the side of your chest between your ribs to perform the procedure. The robot is equipped with a camera so your surgeon can get a clear view of your heart.
• Thoracoscopic surgery: Your surgeon will insert a long tube and camera called a thoracoscope through a small incision in your chest and between your ribs to view your heart. The procedure will be performed using long, thin tools inserted through additional or the same incision.

Traditional open-heart surgery is the standard approach for many cases, because it provides your surgeon with clear access to and visualization of the heart. In most cases, this type of heart surgery involves making an incision in the chest through the breastbone (sternotomy). Typically, sternotomy incisions are eight to 10 inches in length.

Minimally invasive heart surgery differs from open heart surgery in its use of small incisions to access the heart. Because minimally invasive surgical procedures avoid a large incision, they are typically less painful and have a quicker recovery period.

The benefits of less invasive heart procedures include:

• Reduced pain after surgery
• Lower infection risk
• Less blood loss
• Smaller, less visible scars
• Improved recovery times and shorter hospital stay
• Fewer physical restrictions after surgery

Many people are candidates for minimally invasive cardiac surgery and your surgeon may allow you to decide if you want to proceed with a minimally invasive procedure or opt for traditional open-heart surgery. Your care team will discuss the risks and benefits of the operations and explain what is involved to help you make the decision that aligns with your lifestyle and healthcare goals. Once you decide, you will go through an extensive screening process to help lessen any possible complications that may arise.

Before recommending a minimally invasive procedure, your care team will consider:

• Your heart’s condition
• Additional procedures that may need to be done at the same time
• Certain lifestyle factors such as smoking or BMI
• Other medical complications that may make surgery too risky

Patients who are not ideal candidates for minimally invasive heart surgery often have several areas of the heart that would benefit more from an open-heart procedure. For those who do not qualify for or are not interested in minimally invasive procedures, Penn cardiac surgeons have extensive experience in open-heart surgeries.

For most people, minimally invasive cardiac surgery has a quicker recovery period than open heart surgery. Because your incisions are smaller, you can expect a shorter hospital stay, with less pain and fewer movement restrictions following surgery.

After your minimally invasive cardiac procedure, you will be transferred to our specialized cardiac intensive care unit for recovery. There, you will be monitored by a highly trained team who will provide skilled care 24 hours a day.

Once you are able, your care team will encourage you to move around as much as possible during your hospital stay. Most patients can expect a two to five-day hospital stay following minimally invasive heart surgery. During that time, your team will set movement goals and a respiratory therapist will teach you breathing and coughing exercises to help keep your lungs clear.

Once you are discharged from the hospital, your care team will offer guidance on rest, incision care, medication, and follow-up appointments. You may also be recommended to attend cardiac rehabilitation to help you regain strength and stamina.

At Penn Medicine, our surgeons and clinicians remain at the forefront of minimally invasive cardiac surgery by practicing the latest techniques. At Penn Medicine, you can expect:

• World-renowned experience: Penn cardiac surgeons are innovators in their field. They develop new techniques and procedures to help improve outcomes.
• Industry-leading hybrid operating rooms: We offer state-of-the-art facilities with the latest technologies. Our hybrid operating rooms offer advanced imaging capabilities. In this state-of-the-art suite, your care team can perform catheter-based procedures, minimally invasive surgical procedures, and traditional operations. The benefit for patients is that specialists can perform multiple procedures at one time.
• Care close to home: Penn cardiac surgeons see patients in satellite locations across the community allowing convenient consultations, second opinions, and pre- and post-operative care close to home.