Minimally Invasive Cardiac Surgery (MICS): What It Is and Why More Heart Patients Are Choosing It

Minimally Invasive Cardiac Surgery or MICS is a relatively new concept involving smaller incisions into the patient’s chest as compared to traditional methods. MICS is indicated in the repair and replacement of valves, selected coronary interventions, and the treatment of some congenital heart diseases.

Thanks to the smaller incisions, the patient experiences less pain, trauma, and short-term hospitalization than with conventional surgery. However, it is essential to highlight that MICS is not some ordinary intervention; it is a complex and serious procedure, which comes with all the risks associated with heart surgery. MICS is indicated only in particular conditions when it is justified. Heart surgery usually is a complicated and strenuous intervention, and many patients fear large incisions, month-long recovery, and long hospitalization. This is not surprising, as conventional surgery is among the most traumatic operations with thousands of post-surgery complications. Luckily, there are alternative treatments to standard open-heart interventions, one of which is minimally invasive cardiac surgery. Basically, MICS is just a modified version of standard surgery that allows making smaller incisions resulting in less trauma to the patient’s body.

It is crucial for the patient and his family to understand what kind of surgery is indicated for their condition and how it will benefit them. In this article, we will discuss what MICS is, what heart diseases can be treated with it, how it is performed, and what advantages it provides.

Minimally invasive cardiac surgery is a form of surgery involving small “minimally invasive” incisions as compared to traditional sternotomy or open-heart surgery. In other words, the surgeon makes an incision between the ribs (thoracotomy) and reaches the heart directly through the opening. Thoracotomy can be made either on the left or right side of the patient’s chest; specialized cardiac surgical instruments allow the surgeon to access and operate on the heart. Additionally, in some cases, a surgeon can make a small incision in the patient’s chest and examine the inside of it with a thoracoscope (a telescopic camera). Moreover, the most modern form of robotic-assisted heart surgery allows a robot to perform some of the most delicate interventions in the heart with unprecedented precision.

Usually, open-heart surgery is compared to taking a big piece of front wall of the house to get access to the kitchen, and MICS is taking a window to enter the kitchen. The goal is the same, but the means differ.

There is a long list of heart diseases treatable with minimally invasive surgery. Firstly, it is essential to know that minimally invasive surgery is not indicated for all cardiac surgical interventions. It should be highlighted that some of the most common heart valve repair and replacement procedures are associated with minimally invasive surgery. The heart has four valves: aorta, mitral, pulmonary, and tricuspid. All of them are responsible for preventing blood leakage; however, the mitral valve is the most common one to be operated on. The surgeon repairs or replaces the valve if it is damaged or deformed.

Apart from the mitral, the aortic valve can sometimes be replaced with minimally invasive surgery as well. It is indicated for the treatment of aortic valve stenosis or insufficiency. Additionally, coronary artery bypass graft, or bypass surgery can be performed using a minimally invasive approach in some patients. Finally, minimally invasive cardiac surgery can be used for repairing some holes in the heart, congenital heart defects, removing tumors, and treating some arrhythmia.

Thus, it is the cardiologist and cardiac surgeon who decide whether MICS is indicated for the patient. They analyze the patient’s condition, weight, age, and other diseases.

It is typical for the patient to discuss with his cardiologist and cardiac surgeon the opportunity to reduce trauma to the body while treating his condition. Indeed, the main advantage of MICS is that it is less traumatic than conventional surgery. As was mentioned above, MICS involves smaller incisions as compared to sternotomy. In other words, the patient will have less pain and trauma after minimally invasive surgery. Another advantage of MICS is a shorter recovery than with traditional surgery. This is undoubtedly an advantage for working people who wish to recover as soon as possible and return to their everyday routine. In addition, minimally invasive surgery leaves less noticeable scars on the body, which is also an advantage for some people who do not want to have aesthetic defects after the operation. However, it should be emphasized that MICS is not always better and safer than conventional surgery; it is only indicated in some cases when it brings more benefits to the patient.

Undoubtedly, this is one of the most pressing questions for the patient: is he eligible for MICS? Mostly, it depends on the type of intervention and the patient’s condition; for example, some valve surgeries are less technically demanding and can be categorized as minimally invasive, while others are more complicated and require traditional open-heart surgery to date. Secondly, the patient’s age is a vital parameter. In principle, MICS is appropriate for all ages, but older people generally tolerate this type of intervention better than young ones. In other words, the 70-year-old healthy patient will tolerate MICS better than the 40-year-old one with diabetes, obesity, lung disease, and multiple previous surgeries. Finally, the cardiologist and cardiac surgeon will evaluate the patient’s weight, laboratory tests, and diagnostic imaging. Echocardiography, coronary angiography, and heart CT scan are among the most crucial tests for determining eligibility for MICS.

The surgeon will also take into account kidney function, lung function, endocrine system, and blood pressure. If the patient has diabetes or hypertension, he needs to bring the disease under control before surgery. Of course, in the days leading up to the operation, the patient should give up alcohol and smoking. Needless to say, the patient must consult an anesthesiologist and cardiac surgeon to go over all the details of the intervention. In general, all the above is necessary to reduce the stress on the body and ensure the safe course of the intervention on the day of the operation.

During MICS, the patient is under general anesthesia and therefore does not feel anything. The surgeon makes an incision on the side of the chest, which is significantly smaller than the traditional one. The ribs are opened to access the heart. In addition, the surgeon needs to insert specialized forceps into the incision to operate. In addition, a thoracoscopy can be used to examine the interior of the chest. Moreover, the heart-lung machine is used, in which the blood circulating through the heart and lungs is pumped. The duration of the intervention varies depending on the type of surgery, but it rarely exceeds six hours. The surgeon finishes the operation, and the incision is sutured; the patient is transferred to the intensive care unit.

It is vital to emphasize that despite the small size of the incision, MICS is a serious intervention that requires a long rehabilitation period.

MICS is a relatively safe and effective procedure that decreases post-surgery trauma and facilitates the patient’s recovery. Nevertheless, it is essential to comprehend that it is not always better in comparison with standard open-heart surgery. It is the cardiologist and cardiac surgeon who decide which type of intervention is appropriate for the patient with regard to his condition, weight, age, and other factors. If you are diagnosed with a heart disease and opted for surgery, be sure to discuss with your doctor whether MICS is available and learn all nuances of the intervention. In conclusion, heart surgery is a serious procedure, but the right attitude and recovery will help the patient return to his everyday life after the operation.