What is Minimally Invasive Cardiac Surgery or Keyhole Surgery - Health Education - DesiMD Healthcare - India
Health Education

Minimally Invasive Cardiac Surgery

Dr.N N Khanna profile Authored by Dr.N N Khanna on 26 May 2014 - 15:48.

What is minimally invasive cardiac (heart) surgery or keyhole surgery?

A minimally invasive heart surgery is performed through a small incision between the ribs on your chest (3-4 inches), instead of large incisions (6-8 inches) as in traditional surgery. During this surgery, the functioning of the heart is stopped during the surgery and the blood flow is diverted using the heart-lung machine. It is often chosen as an alternative to open heart surgery. It is less painful and has a speedy recovery as compared to other heart surgery options. Usually, the doctor will choose a minimally invasive heart surgery as an option only whenthe patient hasno history of a heart surgery in the past.

Following are the commonly performed minimally invasive cardiac surgeries:

  • Tricuspid valve surgery
  • Aortic valve surgery
  • Surgery for atrial septal defect closure
  • Atrioventricular septal defect surgery
  • Surgery for removing leg vein
  • Surgery of mitral valve
  • Maze heart surgery

What are the types of minimally invasive cardiac surgeries?

Minimally invasive cardiac surgery is broadly categorized into two types:

1.      Robot-assisted cardiac surgery

2.      Thoracoscopic surgery

Robot-assisted cardiac surgery or closed-chest heart surgery: It is the surgery performed with the help of computerized robotic thin arms, which is controlled and operated by the surgeon. In this, movements of surgeon’s hand are duplicated by the robotic arms and surgical assistants on the operating table, to change surgical equipment attached to a robotic arm. The whole procedure requires a very small incision (less than 2 inches). During the procedure, the surgeon can see the ongoing procedure, on HD monitor.

Types of Robotically Assisted Heart Surgeries:

  • Robotically Assisted mitral valve repair
  • Robotically Assisted CABG surgery
  • Robotically assisted atrial septal defect (ASD)
  • Robotically assisted patent foramen ovale (PFO) repair surgeries
  • Robotically Assisted surgery to remove cardiac tumor
  • ​Robotically Assisted heart device (pacemaker or valve) implant
  • Robotically Assisted surgery for atrial fibrillation
  • ​Thoracoscopic surgery or mini-thoracotomy:It is the heart surgery performed with the help of thorascope(a thin tube equipped with high -definition video camera). A small incision is made in the patient’s chest, between the ribs and then the thorascope is inserted into it, to repair the heart.

When is the minimally invasive heart surgery needed?

Usually, minimally invasive heart surgery is recommended when the heart gets insufficient blood supply due to blockage in the arteries. This condition is called as coronary artery disease (ischemic heart disease) which is often represented by severe chest pain. However, doctorsmay try to treat these conditions with medication or some other procedures like angioplasty or stenting.

What can the patient expect before, during and after the surgery?

Before the procedure:

  • Doctor may ask the patient to stop taking certain medications (at least 2 weeks before the surgery) including naproxen, ibuprofen, clopidogreland aspirin which interferes with blood clotting and may increase the risk of bleeding during the surgery.
  • Every medication should be taken under the expert’s supervision only.
  • Patient may be asked to quit smoking (if he/she smokes)
  • Immediate consultation may be needed in case of fever, cold, herpes or other illnesses.
  • Patient will be sterilized. (cleaned by washing the body and scrubbing the operation site using a special soap)
  • Patient may not be allowed to eat or drink anything after midnight of the planned surgery day.
  • Patient may be allowed to wet the mouth if it is dry.

Patient may be given certain medicines before the surgery.

During the procedure:

  • Patient may be thoroughly examined using blood tests and several imaging studies
  • Patient or close relative may have to sign a consent form.
  • Patient will be anesthetized.
  • A procedure will be performed by making an incision in the chest
  • A healthy blood vessel is prepared in the chest wall (using a standard instrument)
  • This healthy blood vessel is then connected to the heart to provide blood to the blocked coronary arteries.
  • Procedure may be repeated if multiple arteries are blocked.
  • At the end, all the incisions will be closed.

After the procedure:

  • Patient may have to stay in the Cardiac Surgery Intensive Care Unit (CSICU) for at least 24 hours or longer, if needed.
  • Once CSICU is not needed, patient will be shifted to the regular ward.
  • Patient may have to stay in the hospital for about 4 days, or longer in case of anycomplications.
  • Complete recovery from the surgery may take time (about 2 to 3 weeks)

What are the benefits of minimally invasive heart surgery?

Minimally invasive heart surgery offers the following benefits, when compared with the other heart surgeries:

  • Small cut and thus less pain and smaller scars.
  • Minimum loss of blood during the surgery.
  • Less chances of surgical site infections.
  • Lower risk of trauma.
  • Shorter duration of hospitalization.
  • Fast recovery, you can go back to your normal routine (within 1 to 4 weeks).
  • Rarely needs a blood transfusion.
  • Robotically assisted heart surgery do not requires splittingof breastbones.
  • Improvements in pulmonary functions after the procedure.
  • Improved quality of life.

What are the exercise recommendations after the surgery?

Recommended exercises :

  • Cycling
  • Brisk walking
  • Swimming
  • Other forms of aerobic exercises

Recommended Duration:

  • Almost 40 min / day (first 5 min warm-up, last 5 min cooling-down and 30 min actual exercise)
  • This schedule is recommended for about 6 weeks after the procedure
  • First 3 months mild exercise and in later gradual increase in exercise intensity


  • Retrains heart to work more efficiently
  • Dilates heart arteries
  • Conditions heart muscles
  • Takes away the bad cholesterol


  • Avoid over exertion
  • Avoid weight lifting and muscle building exercises
  • Avoid exercise without supervision
  • Avoid sport exercises
  • Check pulse regularly

When to stop exercise immediately?

  • Chest pain
  • Fatigue
  • Dizziness
  • Breathlessness

What care one need to take after the procedure?

  • Do not smoke
  • Eat healthy diet
  • Perform regular exercises
  • Keep track of blood pressure and other health parameters
  • Keep track of blood sugar level and blood cholesterol level
  • Maintain a healthy weight
  • Keep the doctor updated with your health issues and improvements.
  • Get a Preventive Heart Check up done.

What are the expected risks after the procedure?

Risks after the minimally invasive heart are rare, but one may experience the following:

  • Blood loss
  • Blood clotting (causing pulmonary embolism)
  • Heart attack
  • Stroke
  • Infections (including surgical site, lung or urinary tract infection)
  • Difficulty in breathing.
*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.