Christopher  L. La Mendola, MD FACS FACC

Over the past decade, minimally invasive surgery has become an accepted approach to certain types of open-heart surgery.  Generally, minimally invasive surgery means surgery through an incision considerably smaller than the incinsion used in a  traditional "sternotomy". 

There are many advantages to minimally invasive open-heart surgery, but there are limitations to its use, and so it is important for you to understand what can and perhaps, should be performend minimally invasively, and what cannot and probably shoud not be performed through a small incision.  This  is a controversial topic  among heart surgeons and so can be particularly confusing to  patients.

Aortic valve surgery is well-suited to a minimally invasive approach.  Usually a small incision is made in the upper portion of the breastbone, while leaving most of the breastbone intact.  Using this technique, no other incisions are needed.  The operative time is shorter, and generally it is less painful than a larger incision.  This is the standard technique that

Dr. La Mendola prefers to use.  Some surgeons use a technique that involves an incision in the upper right side of the chest, but this necessitates an incision in the groin as well, and so, you should always ask about which approach is planned.

A small incision in the upper breastbone (without any other incisions) is also useful for repairing Aortic aneurysms. This is a technique used by the surgeons at the primary teaching hospital of Harvard University, the Brigham and Women's Hospital. 

Dr. La Mendola is one of a handful of surgeons in the country who have succcessfully used this technique to repair Thoracic aneurysms.

Minimally invasive surgery is also useful for performing Mitral valve repairs and replacements, although this technique almost always invovles two incisions, one in the upper right chest and one in the groin.  Although this is being used by some surgeons as a standard technique, Dr. La Mendola has been more selective in its use for several reasons.  First, although it is a cosmetically pleasing incision, any incision between the ribs, no matter how small, has the potential to be considerably more painful than an "old-fashioned" sternotomy. The degree of  pain after this type of incision is somewhat unpredictable; sometimes its better, and sometimes its worse than a more traditional incision.  Second, the incidence of respiratory complications after this type of incision may be higher than with a midline sternotomy.  The ultimate choice of incision in mitral valve surgery should be carefully discussed with your surgeon.

Although many surgeons have attempted to perform coronary bypass surgery through a small incision, it is generally felt by most heart surgeons that the results of minimally invasive coronary bypass surgery have been less than ideal, an as such it can not be recommended.