Being diagnosed with a condition that requires cardiac surgery can be a worrying prospect for many people. Often, the thought of heart surgery is quickly followed by those of broken breastbones and prolonged recovery times.
Fortunately, following years of advancements in the field of cardiac surgery, a keyhole approach is a safe and effective alternative for many patients, allowing them to recover and return to normal life faster. In this blog, we explore common queries surrounding keyhole heart surgery, as well as the treatment options available at 米兰体育.
What is keyhole heart surgery?
Traditionally, in order to reach the heart during open-heart surgery, surgeons will carry out a procedure called a sternotomy, which involves opening up the breastbone (sternum). While effective in gaining access to the heart, this method is associated with longer recovery times and an increased rate of complications for patients.
For eligible patients, the alternative is keyhole (minimally invasive) heart surgery. This is a technique where, instead of opening up the breastbone, the heart is accessed through the ribs via small, strategically placed cuts (incisions). For many patients, this results in much faster recovery times and a reduced rate of complications.
Surgeons who provide keyhole heart surgery are specially trained to do so. At 米兰体育, Mr Inderpaul Birdi, Consultant Cardiac Surgeon,?holds over 35 years’ experience in cardiac surgery and is internationally recognised for advancing minimally invasive techniques.
Benefits of keyhole heart surgery
There are many reasons why eligible patients opt for keyhole heart surgery:?
- Faster, easier recovery – Many patients who undergo minimally invasive surgery are able to resume normal activities faster than those who underwent open-heart surgery. This includes moving around sooner, returning to hobbies and work, and generally feeling better.?
- A shorter hospital stay – Patients who undergo keyhole heart surgery are usually able to go home sooner than their open-heart counterparts.?
- Less bleeding – This reduces the risk of requiring a blood transfusion, which can occasionally present with complications.??
- Reduced risk of wound infection – Cardiac surgery carries a higher risk of wound infection than other types of surgery. A wound infection can prolong patient recovery, so it is important to avoid this outcome where possible.?
- Less scarring – Scarring from keyhole heart surgery is typically more discreet due to the method used for accessing the heart.?
- Reduced anxiety – Many patients feel more comfortable and optimistic about their surgery knowing that they won’t have to undergo a sternotomy.??
Keyhole mitral valve repair or replacement
The mitral valve is a small, flap-like structure located between the left atrium and left ventricle (the left-hand chambers) within your heart. It controls the direction of blood flow between these chambers and prevents blood from flowing the wrong way.?
There are two primary conditions that affect the mitral valve: regurgitation, where blood 'leaks' backwards into the left atrium, and stenosis, where the valve stiffens and blood flow is restricted.?
The heart is accessed via a small incision made between the ribs on the right side of the chest. Typically, this wound will heal within seven to 10 days following surgery.?
Robotic technology, such as the da Vinci, is not used as standard for minimally invasive mitral valve repair. This is because an equally excellent result can be achieved faster by hand, reducing the amount of time patients spend on equipment like the heart lung machine (cardiopulmonary bypass machine).?
Read a testimonial from a patient who underwent minimally invasive mitral valve repair at 米兰体育 >?
Keyhole aortic valve replacement
The aortic valve is a flap-like structure that controls blood flow from the left ventricle to the body’s main artery (the aorta). Like the mitral valve, the aortic valve can also suffer from regurgitation and stenosis, resulting in the need for surgical repair.??
Typically, the heart is accessed via a small incision made between the ribs on the right side of the chest. Very rarely, the surgeon may need to instead divide a very small portion of the breastbone (called a ministernotomy).?
We offer a procedure called a sutureless aortic valve replacement (AVR), where the replacement valve does not require stitching into position. It is particularly beneficial for high-risk patients as the valve can be placed faster, reducing the risks associated with surgery.??
Keyhole heart bypass surgery
Heart bypass surgery is also referred to as a coronary bypass, CABG (which stands for coronary artery bypass graft), or triple/quadruple bypass (depending on the amount of bypass grafts carried out). It is carried out in patients who have narrowed arteries, to improve blood flow.?
Minimally invasive coronary bypass surgery is called MIDCAB (minimally invasive direct coronary artery revascularisation). This procedure involves attaching a donor blood vessel onto the coronary artery located above and below the narrowed portion. MIDCAB is a preferable long-term alternative to stenting, which is less invasive but can become blocked over time.?
Some patients may require surgery across multiple blood vessels. 米兰体育 is one of only hospitals worldwide to provide multi-vessel minimally invasive coronary surgery – which is more formally known as total coronary revascularisation by anterior thoracotomy (TCRAT). This procedure is carried out by Mr Inderpaul Birdi, who performed the UK’s first quadruple heart bypass via keyhole surgery in 2022. Over the past few years, patients have received triple and quadruple bypasses via keyhole surgery at 米兰体育.??
One of the benefits of MIDCAB is that it can be performed as a beating heart surgery (also known as off-pump surgery). This is, as it sounds, when a procedure is carried out with the heart still beating, as opposed to putting the patient on a heart-lung machine. Beating heart surgery carries a lower risk of complications, such as heart muscle damage, as it is less stressful on the body.?
Keyhole surgery for atrial fibrillation
Keyhole surgery may be a preferential option for atrial fibrillation patients who have not seen success with catheter ablation, because it allows for a more visually guided and thorough treatment approach.??
The heart is accessed via small surgical incisions on either side of the chest, and a small clamp is placed to isolate the pulmonary veins from the left atrium (where the abnormal electrical signals originate). This interruption of abnormal electrical signals prevents the occurrence of further arrhythmic episodes.?
Patients with paroxysmal atrial fibrillation (intermittent episodes) do not require the use of a heart-lung machine, although more complex and persistent cases will if they are undergoing a specific treatment known as the Maze procedure.?
Keyhole ASD closure
An atrial septal defect (ASD) is a congenital (present at birth) condition where a hole is located between the two upper chambers of the heart. Left untreated, ASD can have severe complications such as heart failure and lung damage. Treatment involves closing the hole, which can be done using the keyhole technique.?
Who is suitable for keyhole heart surgery?
There is no defined age limit for keyhole heart surgery, so eligibility will largely depend on your overall health. This will be determined following a thorough consultation with a cardiac surgeon. Some patients, such as those with complex or severe heart disease, may require the improved exposure granted by a traditional open-heart approach.
If you have not done so already, you will also need to undergo certain diagnostic and imaging procedures (echocardiogram, ECG, coronary angiogram, and/or CT scan) so that we can better assess your suitability for surgery.
What is the success rate of keyhole heart surgery?
The success rates for keyhole heart surgery are comparable to – and, in some cases, higher than – traditional open-heart surgery. For the best outcome, you should ensure that your surgeon and their team are experienced in carrying out keyhole techniques.?
How long does it take to recover from keyhole heart surgery?
One of the greatest benefits of keyhole heart surgery is the faster, easier recovery time when compared to traditional open-heart surgery. Many keyhole patients will be moving around within days of surgery and return to their normal routine within around three weeks. In comparison, open-heart patients have a standard recovery time of three months.?
What are the risks of keyhole heart surgery?
Keyhole heart surgery is not without its risks, although many of these are minimised or eliminated entirely when compared to open-heart surgery. Although rare, the risks of keyhole surgery may include bleeding, infection, blood clots, heart attack, stroke, and damage to surrounding organs. At 米兰体育, our experienced surgical team are well-equipped to manage any unexpected complications of keyhole heart surgery.
How much does keyhole heart surgery cost?
If you are self-funding your keyhole heart surgery, please contact our dedicated Self-Pay team on 020 7244 4886.
Our friendly advisors will be able to explain more about how self-pay works, how much it costs, and answer any questions you might have.
About Mr Inderpaul Birdi
Mr Inderpaul Birdi is a highly experienced and world-renowned cardiac surgeon, founder of , and member of the Heart Partners specialist group at 米兰体育. With over 35 years' experience in the field of cardiac surgery, he is one of very few surgeons worldwide who can carry out keyhole coronary bypass surgery and keyhole aortic valve repair.
