Why MemorialCare Heart & Vascular Institute
At the MemorialCare Heart & Vascular Institute, our focus is to treat complex cardiovascular diseases in the least invasive way possible. As one of the region's most experienced teams in minimally invasive procedures, we’re able to perform lifesaving procedures to treat a full gamut of diseases of the coronary and carotid arteries, valves, and blood vessels, as well as repairs to damaged hearts from myocardial infarction and irregular rhythms. Compared to traditional open-heart surgery, this approach can result in less scarring and accelerated healing and recovery.
Meet our Chief Cardiovascular Surgeon
Marc Sakwa, MD
Dr. Sakwa is a board-certified cardiothoracic surgeon who specializes in minimally invasive procedures for complex heart conditions. He also serves as medical director for adult cardiovascular surgery at MemorialCare Long Beach Medical Center. Recognized as a Top Los Angeles Doctor more than once by the Los Angeles Business Journal, Dr. Sakwa is considered an expert in aortic and mitral valve heart surgery using small incisions under three inches in length to access and repair the heart. Having published numerous articles in peer-reviewed journals, his research focuses on valvular repair, replacement, and the evaluation of new technologies for valve disease.
What is Minimally Invasive Cardiac Surgery?
There are two surgical options for patients facing cardiac surgery: traditional open-heart surgery or minimally invasive cardiac surgery, also known as MICS. In both cases, the surgeon needs to access the heart for repair.
While traditional open-heart surgery requires creating an 8-inch opening in the chest and cutting through the breastbone, a procedure called a sternotomy, minimally invasive cardiac surgery does not.
Instead, with minimally invasive cardiac surgery, the surgeon gains access to the heart by making small, 2- to 3-inch incisions in the patient’s right chest to create narrow tubing pathways between the ribs for surgical instruments and catheter insertions. To ensure precision and accuracy, they are aided by advanced imaging technology, such as high-definition cameras that can provide real-time 3D imaging, precise, state-of-the-art surgical instruments, and robotic assistance. The end result is far less trauma to the body as the chest and breastbone are not cut into.
Minimally invasive cardiac surgery has been used to treat heart conditions for more than two decades. It has proven to be widely applicable, safe, and effective.
What are the benefits of undergoing minimally invasive surgery vs. traditional open-heart surgery?
Because open-heart surgery usually requires a four-to-five-day stay in the hospital followed by a six-to-eight-week period for the breastbone and muscles to heal, it can be very stressful on the human body. In comparison, minimally invasive cardiac surgery generally requires a shorter hospital stay and about three to four weeks for full recovery, allowing the patient to return to work or normal activities much sooner.
Benefits of minimally invasive surgery include:
- Reduced post-operative pain
- Smaller incisions produce less scarring
- Faster recovery time
- Decreased length of hospital stay
- Lower risk of infection or complications
- Less damage to muscle and tissue
- Less blood loss
Minimally invasive cardiac surgery can be utilized to treat various conditions related to the heart and its structures. Some common conditions that can be addressed through minimally invasive approaches include:
- Atrial Fibrillation
- Atrial Septal Defect
- Coronary Artery Disease
- Adult Congenital Heart Disease
- Aortic valve insufficiency (aortic disease)
- Mitral valve stenosis
- Marfan Syndrome
- Heart disease
- Heart attack
- Aortic valve stenosis
- Aortic valve regurgitation
- Aortic valve prolapse
- Mitral valve disease
- Mitral regurgitation
- Mitral stenosis
- Aortic valve disease
- Pulmonic valve disease
- Pulmonic regurgitation
- Pulmonic stenosis
What are the different types of minimally invasive procedures offered?
Minimally invasive procedures offer a range of options for treating various cardiovascular conditions. Here are some different types of minimally invasive procedures commonly offered at MemorialCare:
- Minimally invasive aortic valve replacement or repair
- Minimally invasive mitral valve replacement or repair
- Minimally invasive tricuspid valve replacement or repair
- Minimally invasive thoracic aortic aneurysm repair
- Minimally Invasive Direct Coronary Artery Bypass “MIDCAB”
Who is a good candidate for minimally invasive cardiac surgery?
We recommend that you discuss the possibility of minimally invasive cardiac surgery with your cardiologist as each patient is unique.
Advances in research, imaging, surgical technology, and clinical expertise in cardiology and cardiovascular surgery have made less invasive approaches to heart surgery available for more patients. Additionally, certain individuals may benefit from minimally invasive cardiac surgery, such as those considered too high risk for traditional surgery. This may include patients who are elderly, frail or have other health conditions such as diabetes or obesity. This procedure may also benefit younger patients in earlier stages of heart disease.
At MemorialCare, we believe in getting a team consensus on which procedure is best for each individual patient. Our cardiovascular physicians and surgeons serve on a multi-disciplinary team that reviews each patient’s condition and risk factors to reach a consensus on the best, yet least invasive treatment plan for that individual. Additionally, testing is an important aspect of our program and aids in determining the best course of action.
What can I expect during the minimally invasive heart surgery procedure?
Preparing for minimally invasive cardiac surgery
If you are a good candidate for minimally invasive cardiac surgery, your MemorialCare surgeon and treatment team will explain what to expect before, during, and after the procedure.
You may need to temporarily stop taking medications, restrict food intake before the procedure, and have hair shaved on your body around the planned incision area.
During the procedure
Minimally invasive cardiac surgery usually takes about three to four hours, during which the patient is under anesthesia. As in traditional open-heart surgery, the use of a heart-lung bypass machine to keep the blood moving through the body is often used. This is especially true for those with weak or dilated hearts. Additionally, just as in traditional surgery, the heart is stopped and safeguarded using a solution that protects it from damage.
During the surgery, the cardiac surgeon makes small incisions on the right side of the patient's chest, which allow for small surgical tools or robotic arms to be inserted. Carefully navigating between the ribs, the surgeon reaches the heart to perform the necessary procedure. Finally, the incisions are closed using dissolvable stitches that do not need to be removed.
Post-surgery care and recovery
Patients who undergo minimally invasive heart surgery are often up and about within a few days, and back to their normal activities within a few weeks. Following treatment, patients are generally enrolled in rehabilitation therapy.
Following the minimally invasive heart surgery procedure, your recovery will involve a step-by-step process that includes close monitoring, pain management, and gradually increasing physical activity. Here is what you can expect:
- Intensive Care Unit (ICU) Stay: After the procedure, you will typically spend about a day in the ICU. During this time, you will receive fluids and medications through intravenous (IV) lines. Tubes placed during surgery will drain urine from your bladder and fluid and blood from your chest. In some cases, you may also receive oxygen if needed through a face mask or nasal prongs to assist with breathing.
- Transition to a Regular Hospital Room: Once your condition stabilizes, you will be transferred to a regular hospital room, where you will stay for several days. Your MemorialCare treatment team will monitor your overall condition by watching for any signs of infection in your incision sites, working closely with you to manage any post-surgery pain effectively while ensuring your comfort, and assisting you in gently and gradually increasing your activity level. The length of your ICU and hospital stay will depend on the specific procedure performed and your individual condition.
- Returning to daily activities and rehabilitation therapy: MemorialCare’s Cardiac Rehabilitation Programs are designed to help those with heart conditions recover, as well as resume, develop and/or maintain an active, heart-healthy lifestyle. With prevention and support as part of our complete cardiac care services, our patients can access nutrition counseling, structured exercise, risk factor modification, education opportunities, and a support group.
Remember that everyone's recovery timeline may vary, and it is crucial to listen to your body and gradually increase your activities as directed by your MemorialCare healthcare team. By following the prescribed care plan and gradually returning to your normal routine, you can optimize your recovery from minimally invasive cardiac surgery and regain your health and well-being.
FAQ about minimally invasive heart surgery
Minimally invasive cardiac surgery is a safe procedure and has demonstrated favorable outcomes when compared to traditional surgery. It offers several advantages over traditional open-heart surgery, such as reduced trauma, shorter hospital stays, faster recovery, and improved cosmetic results. However, as with any surgical procedure, there are inherent risks, and patient-specific factors may influence safety. It's important to discuss the risks and benefits with a MemorialCare healthcare professional to make an informed decision.
While minimally invasive cardiac surgery has a far lower risk of complications compared to traditional open-heart surgery, there are still some potential risks involved. These can include bleeding, infection, blood clots, damage to surrounding structures, arrhythmias, and adverse reactions to anesthesia. Additionally, there is a small (about one percent) possibility of converting to open-heart surgery during the procedure if the surgeon encounters unexpected complexities or challenges.
The recovery time for minimally invasive heart surgery varies depending on the specific procedure performed, the patient's overall health, and individual factors. However, compared to traditional open-heart surgery, minimally invasive approaches generally offer significantly faster recovery times. Patients may expect a shorter hospital stay, typically ranging from a few days to a week, and a quicker return to normal activities, often within a few weeks.
Minimally invasive cardiac surgery procedures usually take about three to four hours, during which the patient is under anesthesia.
Robot-assisted heart surgery is a minimally invasive surgical technique that involves the use of robotic systems to assist the surgeon during the procedure. The surgeon controls robotic arms that hold and manipulate specialized surgical instruments with precision and flexibility. The robotic system provides enhanced visualization and allows for precise movements, enabling complex cardiac procedures to be performed with smaller incisions, reduced trauma, and improved patient outcomes.
Minimally invasive heart surgery involves smaller incisions and specialized techniques, while open-heart surgery typically requires a large incision in the chest. Additionally, minimally invasive procedures often use specialized instruments and endoscopic cameras for visualization and generally result in reduced trauma, faster recovery, and shorter hospital stays compared to open-heart surgery.
