This document discusses minimally invasive cardiac surgery as an alternative to traditional open-heart surgery approaches. It describes different levels of minimally invasive techniques from direct vision mini-incisions to robotic-assisted port incisions. Specific minimally invasive approaches are outlined for aortic, mitral valve, coronary, and atrial septal defect surgeries. The advantages of minimally invasive surgery are noted as reduced pain, bleeding, recovery time, and improved cosmesis. However, it also requires more specialized training and equipment and may not be suitable for all patients. Early results from studies comparing minimally invasive to traditional approaches found equal mortality and neurological events despite longer surgery and bypass times with minimally invasive surgery.

1. Dicky A.Wartono ,dr SpBTKV(K) 2022
Minimally Invasif Cardiac Surgery

2. Nothing to Disclose

5. 1. Mitral valve Surgery
2. Atrial Septal Defect Surgical Closure
3. Aortic Valve Surgery
4. Coronary Surgery
5. Hybrid Surgery
6. Aortic Surgery

9. Minimally Invasif Cardiac Surgery
Traditional Approach
Full Sternotomy
CardioPulmonary Bypass

10. Minimally Invasif Cardiac Surgery
Traditional Approach
Full Sternotomy
CardioPulmonary Bypass

11. Minimally Invasif Cardiac Surgery
Traditional Approach -- Advantages
- Withstood the test of time
- Basic & Most Surgeon Comfortable with
- Full Access for Coronary, Valve & Aorta
- Fast & Ideal surgical field
- Full control of Circulation & Oxygenation

12. Minimally Invasif Cardiac Surgery
Traditional Approach -- Dis Advantages
- Pain
- Blood loss
- Prolonge healing
- Sternal wound problem
- Cosmetic

14. Minimally Invasif Cardiac Surgery
Level 1 Mini Incisions - Direct Vision
Level 2 Micro Incision -Video Assisted
Level 3 Micro or Port Incision - Video Directed
Level 4 Port Incision - Robotic Instrument - Video Directed

15. Minimally Invasif Cardiac Surgery
Aortic Surgery
- Limited Upper Sternotomy
- Upper Right Thoracotomy
Mitral Valve Surgery
- Right antero lateral mini thoracotomy
Coronary Surgery
- Left antero lateral mini thoracotomy
ASD closure
- Left antero lateral mini thoracotomy

16. Minimally Invasif Cardiac Surgery
Aortic Surgery
- Limited Upper Sternotomy
- Upper Right Thoracotomy
Mitral Valve Surgery
- Right antero lateral mini thoracotomy
Coronary Surgery
- Left antero lateral mini thoracotomy
ASD closure
- Left antero lateral mini thoracotomy

17. Minimally Invasif Cardiac Surgery
Aortic Surgery
- Limited Upper Sternotomy
- Upper Right Thoracotomy
Mitral Valve Surgery
- Right antero lateral mini thoracotomy
Coronary Surgery
- Left antero lateral mini thoracotomy
ASD closure
- Left antero lateral mini thoracotomy

18. Minimally Invasif Cardiac Surgery
Aortic Surgery
- Limited Upper Sternotomy
- Upper Right Thoracotomy
Mitral Valve Surgery
- Right antero lateral mini thoracotomy
Coronary Surgery
- Left antero lateral mini thoracotomy
ASD closure
- Left antero lateral mini thoracotomy

19. Minimally Invasif Cardiac Surgery
Advantages
Cosmetics
Less Pain
Less blood loss
rapid healing
No /Minimize sternal problm
Reduce post op ICU/ Hospital stay

20. Minimally Invasif Cardiac Surgery
Dis advantages
Tecnically & time demanding
Specialized training, team & infra structure
Expensive
Extra pre op preparation (peripheral, CT, doppler)
Not For All Patient
Limited control to circulation & ventilation
RIsk of convertion, groin problm & phrenic nerve injury

22. Minimally Invasif Cardiac Surgery
Dis advantages
Morbid obesity
Thoracic cage abnormality
Peripheral arterial desease
Prev intra thoracic surgery
Severe cardiac dysfunction
Concomitamt pathology
Elective, LVEF >30% & euroscore II < 10%

24. Early and Late Results
Robotic
N=35
Direct Approach
P value
Cardioplegia
N=51
No Cardioplegia
N=93
Perioperative MI 0 0 0 -
Mediastinitis 0 0 0 -
Permanent Stroke 0 0 0 -
TIA 0 0 0 -
Prolonged Ventilator 0 0 2(2%) 0.27
Atrial Fibrillation 1(3%) 3(6%) 4(4%) 0.09
Renal Failure 0 0 0 -
Renal Failure, Dialysis 0 0 0 -
Tamponade 0 1(2%) 0 0.28
Reoperation Bleeding 1(3%) 1(2%) 0 0.11
Operative Death 0 0 0 -
Readmit <30 Days 1(3%) 9(18%)* 1(1%) 0.001
Reoperation Mitral Valve 0 0 1(1%) 0.52
*This group is significantly different

28. Conclusions
Most patient do not want a sternotomy
MICS are demanded but at the sametime proven safety, efficacy & durability
are expected in ideal candidat
No level one evidence to justify switching to MICS
Traditional Cardiac Approach still proven longterm success & decreasing M&M
Even most evid demonstrate MICS has equal mortality & neurological event
Despite longer surgical & CPB/Aox time

29. Thank You