The heart is the beating engine of the body, so when it needs a tune up, it’s not taken lightly. Traditionally, a sternotomy—a procedure during which a vertical incision often nine inches long is made down the center of the chest and the breastbone is divided, opening up the sternum—was the only way to access the heart. It’s an invasive surgery that can take months to recover from.
Last year, however, more than a quarter of the nearly 600 patients who underwent major heart surgery at Roper St. Francis received a minimally invasive procedure instead—a modern technique in which instruments are inserted through small incisions, eliminating the need to “crack open” the sternum. Recovery time for these procedures can be as short as between two weeks and a month. Though not every cardiac condition or patient is a candidate, for people with valve disease or atrial fibrillation, minimally invasive surgeries are a true game changer. And the list of conditions treatable with this new technique continues to grow, says Roper St. Francis affiliated cardiothoracic surgeon Scott Ross. “As our technology continues to improve, we’re gaining better visibility and better access to the heart through smaller and smaller incisions,” Dr. Ross says. “In the future, we may see heart surgeries with a less than one- to two-week recovery period—a turnaround time once unthinkable.” Here, he fills us in on how this technique is shaking up the game and helping heal hearts faster than ever before.
Then and Now
The history of heart operations dates back to 1896, when the first recorded heart surgery took place in Germany. It also includes a piece of local lore. In January 1948, 34-year-old Dr. Horace G. Smithy, an assistant professor at the Medical University of South Carolina, successfully removed scar tissue from the heart valve of a young girl at Roper Hospital, thus saving her life. He went on to conduct six more similar surgeries throughout the year before tragically dying from a heart valve condition of his own in October. Dramatic advances in cardiac surgery continued in the 1950s with the development of cardiopulmonary bypass, or the “heart-lung machine,” which allows blood to bypass the heart but continue to pump throughout the body. “The heart-lung machine completely revolutionized heart surgery, allowing surgeons to work inside the heart while the machine performs its functions,” says Dr. Ross, adding that “cardio-protective” strategies have continued to improve throughout the decades since. In the 1990s, for example, doctors discovered a way to operate on the heart while it’s beating. Minimally invasive heart surgeries—which, depending on the type of procedure, may be conducted with or without a bypass machine— began hitting the scene in the early 2000s. Using catheters (flexible tubes inserted through narrow openings) and sometimes robot-assisted machines to perform the operation greatly reduces the size of incisions, which can decrease post-operative pain and risk of infection for the patient.
Who Reaps the Rewards?
The list of cardiac conditions treatable by minimally invasive techniques continues to grow. Today at Roper St. Francis, they are most frequently used to remedy heart valve disease and atrial fibrillation, says Dr. Ross. Valvular disease is characterized by a malfunctioning of the mitral, aortic, tricuspid, or pulmonary valves—the four passageways through which blood travels through the heart. According to the Heart Valve Society of America, more than five million Americans are impacted by this condition, which can manifest as either valve stenosis—a hardening of tissue that causes the valve to narrow—or valve insufficiency, which, also known as “leaky valve,” occurs when the valve does not close completely.
Atrial fibrillation (known as AFib) is the most common form of arrhythmia—a condition when the heart beats irregularly, too fast, or too slow—and affects up to six million people in the U.S., says the CDC. Though open-heart surgery used to be the only option for treating both of these common conditions, minimally invasive options are now available as well, says Dr. Ross. For a select group with valve disease, transcatheter aortic valve replacement (TAVR) is a less invasive alternative. “It reduces recovery time from two months to a month or less, and doesn’t leave patients with a long scar across their chest,” says Dr. Ross. And for those with AFib, surgery has evolved from requiring a nine-inch incision and use of a heart-lung machine to an incision as small as two inches and a procedure conducted while the heart continues to beat naturally. In the latter case, patients may be ready to return home within a day or two. “While no heart surgery is one-size-fits-all and, in some cases, a sternotomy might be the best option, for the right people in the right situation, recovery times can be significantly reduced thanks to these less invasive techniques,” says Dr. Ross, noting that success rates for minimally invasive heart surgery are comparable to open-heart procedures.
Hearts of All Ages
In addition to speeding up recovery time, minimally invasive procedures have made life-saving heart surgery an option for more folks than ever before, says Dr. Ross. “Elderly people that were not considered candidates for conventional surgery now have the option of improving—and extending—their lives through these less invasive approaches,” says Dr. Ross. “We have options for a 90-year-old that we didn’t have before.” According to U.S. Census numbers from 2012, the number of people ages 80 and above will climb from 11.5 million to 31 million by 2050, so the implications of this increased reach are dramatic. Whether you’re 28 or 80, the ideal is to avoid surgery altogether, and proactively caring for the health of your heart is the way to do that, says Dr. Ross. But if fate finds your heart in need of extra help, the prognosis is brighter than ever before.
By Stratton Lawrence