Cardiac surgery, commonly called “open heart” surgery, is often met with fear by patients when they first hear it is necessary. People talk of the chest being “cracked open” and a foot long cut down the center of the chest comes to mind.

While opening the breastbone is still necessary, in some patients, surgeons have learned that safe access to the part of the heart that is damaged, can often be achieved without a traumatic incision. Minimally invasive heart surgery has been safely performed for many types of heart valve problems, as well as coronary artery bypass. The first important question is if the procedure is safe and can be accomplished with equal results as traditional surgery. Once the answer is yes, the procedure can then be planned. Minimally invasive heart surgery mainly refers to the approach used, depending on what specifically, is being repaired.

With coronary artery bypass surgery, the incision is typically 3 inches in length on the left side of the chest, just under the breast. The procedure is performed between the 5th and 6th rib, and involves using an artery in the chest (left internal mammary artery or LIMA) sewn to the major artery of the heart (the LAD). This procedure is performed with the heart still beating, using special stabilizing devises to keep that section of the heart still.

Surgical aortic valve replacement can be safely performed with a small incision (about 3 inches) over the second rib, on the right side of the breastbone. The rib is moved and then reattached with a titanium plate. It is important to understand that this will not alarm in the airport and will not cause any prolonged discomfort after surgery.

Mitral valve repair is performed with an incision in the right side of the chest, between the fourth and fifth rib. The repair techniques are the exact same as what are offered with traditional surgery.

Complex aortic surgery can be performed with a partial opening of the breastbone (as an upside-down T incision in the bone. This exposure provides an excellent view of the aorta; allowing for procedures on the aortic root as well as the aortic arch.

The constellation of minimally invasive approaches reduces the need for blood transfusion, speed hospital discharge, and allows for a quicker return to function. It is important when discussing heart surgery with your doctor, that you ask if you are a candidate for minimally invasive surgery and inquire how well trained your surgeon is, in the procedure you require.