Minimally Invasive Cardiac Surgery (MICS)
Information for Healthcare Professionals and Patients
1. What is minimally invasive cardiac surgery or MICS?
Minimally Invasive Cardiac Surgery is the technique of doing heart surgery through small incisions in the chest. It does not require the chest bone or sternum to be cut as with conventional open surgery.
2. What are the other names for minimally invasive cardiac surgery?
Minimally Invasive Cardiac Surgery is also called MICS in short and is also frequently referred to as keyhole heart surgery. Since a video scope is often used to assist in this surgery some may refer to it as endoscopic heart surgery.
3. Are all heart conditions suitable for MICS technique?
Almost all adult heart surgeries are suitable for the keyhole technique. However the surgeon may or may not offer MICS to a patient depending on his comfort in doing it. Since many surgeons are still learning they may not offer MICS to patients whom they perceive as difficult.
4. What percentage of patients are suitable for a minimally invasive procedure (MICS) at your centre?
Approximately 80% of patients are suitable for a minimally invasive procedure at our centre (Apollo Hospital). All patients are reviewed by the Chief Surgeon, Dr Sathyaki Nambala before confirmation. Almost all patients requiring a valve repair or replacement are suitable for a keyhole/endoscopic procedure (MICS). Patients requiring a CABG or bypass operation are screened for suitability for MICS CABG. Usually very complex operations are not performed minimally invasively.
Minimally Invasive Cardiac Surgery can be applied to various cardiac conditions. The most common are
2. Minimally Invasive Valve Surgery
Aortic Valve Replacement
Mitral Valve Repair or Replacement
Multiple Valve Repair/Replacement
3. Minimally Invasive ASD closure also called Keyhole ASD closure
4. Sinus Venosus ASD rerouting
5. Removal of Cardiac Myxoma
These are some of the common procedures. More complex procedures are possible but have to be decided by the operating surgeon on a case to case basis.
Patients Selected for MICS
1. What is MICS CABG?
This is a technique of coronary artery bypass or CABG where in the entire operation is performed from the side of the chest (on the left) through an incision that is about 2 inches.
2. How does it differ from conventional CABG?
Conventional CABG or Coronary artery bypass requires the breast bone or sternum to be cut into half. Recovery from conventional bypass surgery requires a longer duration upto 8 weeks as the bone needs to heal. In MICS CABG, the operation is performed through the side of the chest wall. No bones are cut and healing is rapid. Healing is usually complete in ten days.
3. Will MICS CABG help me leave the hospital early and get back to work?
Definitely yes! This is exactly the reason to do this operation. Hospital stay is as short as 2 days and most patients get back to work or normal life in 10 days. (A regular operation requires 2 months to recover from)
4. Is it a beating heart operation?
Yes, its an offpump or beating heart operation. The support of a pump may rarely be required but the operation is still performed on the beating heart. Pump support may particularly be used when the heart is weak.
5. Are MICS CABG and MIDCAB one and the same?
No, they are not the same. MIDCAB is an old technique where only one or two vessels can be grafted. Its an incomplete operation and is no longer performed. Its often confused with the modern MICS CABG if one is unaware about recent developments.
6. I am a diabetic. Is MICS CABG appropriate for me?
Absolutely. You may be the ideal candidate for MICS as infection rates are almost eliminated. The quality of your vessels will dictate whether you are suitable for this technique and your surgeon is the best judge.
7. What is the risk of infections after MICS CABG?
The risk of infection is close to zero. All infections are reduced dramatically in MICS CABG compared to conventional CABG even in diabetics.
8. I am a smoker/asthmatic. Is MICS CABG still an option for me?
Yes. It could be the ideal option for you. It’s best for your surgeon to take that decision along with your respiratory therapist.
9. My doctor at the clinic I go to says he is unaware of MICS and that it could be dangerous. Is this true?
Most doctors are unaware of latest advances in heart surgery. In its current state MICS is very safe provided its performed by someone specially trained in MICS. Please ask your doctor to speak to us if he wants to know more about minimal access coronary bypass.
10. Are all patients with multivessel blocks candidates for MICS CABG?
No, not all patients with multivessel coronary blocks are candidates. Those with extensive disease or very poor heart function are not suitable for this technique. Your heart surgeon is the best person to decide whether you are a candidate or not for this kind of operation.
11. Is MICS CABG performed in all centers?
No, not all heart surgeons are trained inMICS. Including ours, there are only a handful of centers all over the world that are capable of performing MICS safely. It may be in your best interest to ask yoursurgeon where he trained in MICS so as to ensure that he or she is not experimenting on you.
12. Are heart surgeons in Apollo trained to do MICS CABG?
Yes. Our principal surgeon is well trained in MICS. Dr Sathyaki Nambala initiated the minimal access program and has more than eight years of experience in the technique. His early experience comes from having worked at the Harvard Medical School’s Brigham and Women’s Hospital in Boston, USA. The center has more than a decade of experience and is well known for MICS. You can read his profile here.
Multiple blocked vessels can be bypassed safely in MICS CABG which makes this technique different from others. Our strength has been our ability to safely do multivessel bypass and we routinely do upto 5 grafts with this technique.
We believe in quality outcomes and therefore offer patients post bypass angiograms to study the patency of the grafts that have been placed.Dr Sathyaki Nambala