To Your Health: Heart care goes high tech

By James Hemp, MD, Scripps Health

Just a few years ago, heart surgery often meant a large incision from chest to abdomen, hours of surgery, considerable risks and a week or two in the hospital followed by a long, difficult recovery. In recent years, however, technological advancements have come into the mainstream, offering many patients less-invasive, more successful treatments for heart problems.

One such advancement is the use of minimally invasive robotic surgery to perform coronary artery bypass grafting (CABG). Coronary arteries are the blood vessels that stem from the base of the aorta, the largest artery in the body; they supply the heart with oxygen and nutrients from the blood. Any disease that blocks the coronary arteries can cause serious and often fatal complications. If blockages in the coronary arteries prevent the heart from getting enough oxygen. When the shortage of oxygen becomes critical, the heart muscle begins to die, leading to a heart attack.

CABG, also known as coronary revascularization, is a surgical procedure that reroutes blood flow around the blockages in the coronary arteries so that blood can continue to deliver oxygen to the heart. Traditional coronary revascularization requires a six to eight-inch incision down the front of the chest through the breastbone. The ribcage is then cracked and spread to provide the surgeon with access to the heart. The heart is stopped and the patient is kept alive on a heart-lung machine while the surgeon takes arteries from the arm or leg, as well as leg veins, to create an alternate path around the coronary artery obstruction. When the new path is in place, the patient’s heart is started up again.

Far less invasive than traditional CABG yet equally successful, robot-assisted CABG uses a robotic surgical system which enables the procedure to be performed through only a few small incisions between the ribs. There is no need to break the ribcage or stop the patient’s heart. Instead, the surgeon inserts a high-definition camera, tiny surgical instruments and ultra-thin robotic arms, also inserted through the incision, to construct the detour around the blockage. The camera transmits greatly magnified, three-dimensional images to the surgeon, who controls the movements of the robotic arms while seated at a console. Because the robotic surgical system provides enhanced dexterity, precision and control, it allows a much greater range of motion and more precise movements than the human hand and wrist.

Minimally invasive robotic surgery is also being used to repair damaged mitral valves. One of the four valves within the heart, the mitral valve the mitral valve allows blood to flow through the main pumping chamber in the lower left ventricle. If the valve becomes diseased or damaged, it may not be able to do its job correctly, which can lead to heart failure. In such cases, the mitral valve may need to be repaired. [In some cases, it may need to be replaced.]

As with CABG, traditional mitral valve repair involves a large incision, spreading the ribs, and stopping the heart, while robotic mitral valve repair generally enables the surgeon to perform the procedure through a few small incisions.

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