Minimally Invasive Cardiac Surgery (MICS)

Minimally Invasive Cardiac Surgery is performed through small incisions on the chest. The entry incision is around 3 – 4 finger breadths on either side of the chest, avoiding any bone cutting, rather than the traditional 6-8 inch cut through the centre of the chest cutting open the chest bone (sternum).

Conditions for which MICS can be performed:

MICS consists of various techniques to treat almost all cardiac surgical procedures. For example:

  • Coronary artery disease
  • Aortic/ Mitral valve disease
  • Complex procedures like Bentall’s procedure for arotic root aneurysms, Aortic arch surgeries
  • Congenital heart disease including hole in the heart (ASD, VSD) or any complex structural disease

The heart team approach

A group of cardiologists and surgeons mutually discuss the best possible treatment options for the patient. The treatment options are then discussed with the patient and the family for formulation of final plan of care.

Advantages over the conventional procedure

  • Lower chest wall injury, no bone cutting
  • Less chances of infection
  • Insignificant scars
  • Significantly less blood loss and minimal/No blood transfusions
  • Shorter ICU and hospital stay (4-5 days, instead of 7-8 days in conventional procedure)
  • Quicker recovery and return to active life
  • Better outcome in the remote possibility of re-operation

The Apollo Edge

  • The first group of hospitals to start and pioneer the MICS techniques and systems
  • Full time – in house team of experts to deal with all sorts of cardiac conditions
  • Ability to tackle all emergencies, complexities and complications in case they arise

Robot-assisted Cardiac Surgery

It is a technique of performing complex cardiac surgeries through extremely small incisions with use of cutting edge technology. The size of cut required is less than a finger breadth which drastically reduces the risk of complications, hospital stay and leads to quicker recovery and return to active life.

At Apollo hospitals, Robot assisted cardiac surgeries including CABG, valve replacement surgeries, surgeries for congenital heart surgeries are routinely done putting the life of our patients on a path to speedy recovery.

The heart team approach

For the cardiac illnesses our group of cardiologists and surgeons will discuss about the ideal choice for you. The treatment choices could run across

  • Angioplasty or stenting (interventional cardiology)
  • Conventional open chest surgical procedure (procedure including cutting chest bone and utilization of heart lung machine)
  • Conventional beating heart surgical procedure (procedure including cutting chest bone and operation without the utilization of heart-lung machine)
  • Minimally Invasive Cardiac Surgery – MICS (small access to the heart through a 3-4 inch entry point between the ribs)
  • Robot-assisted cardiac surgery (small access to the heart through 8mm entry points between the ribs)
  • Medical management

Robotic assisted cardiac surgery

Robot helps harvesting of best possible conduits (internal mammary arteries) for CABG though very small cuts in the chest. It also helps the surgeon to perform other cardiac surgeries including valve repairs/replacements in a similar manner.

The 3D amplified vision through the robot assists surgeon to perform the surgery with utmost precision and minimal complications.

Advantages of Robotic assisted surgeries:

  • Lower chest wall injury, no bone cutting, low infection rate
  • Insignificant scars
  • Shorter hospital stay (3-4 days versus 7-8 days in open chest cardiac surgery)
  • Quicker return to active work (1-2 weeks versus 8-10 weeks in open chest cardiac surgery) The Apollo Edge
  • Home to cutting edge technology – Da Vinci Xi Mechanical framework – full time availability of the technical support system
  • Skilled and experienced team of doctors and professionals to perform robotic assist surgeries
  • Ability to tackle all emergencies, complexities and complications in case they arise
  • Cardiothoracic

    Founded in 1996 (January), and recognized as one of the major cardiothoracic surgery units of North India, this division has contributed over 20,000 cardiac surgeries encompassing the entire spectrum of surgical treatment of heart diseases, be it coronary artery bypass, intracardiac repairs of congenital heart defects, valvular heart disease or aortic aneurysm repairs. What sets this department apart is the excellent post operative intensive care which turns out world class success rates.The overall success rate of the surgeries performed so far is over 98% which includes emergency procedures, complex repairs of congenital defects and complicated aneurysm repairs, in addition to large number of coronary artery bypass, valve replacements and simpler congenital defects

    Services

    Cardiac Surgery Consultants and Cardiac Anaesthesia Consultant are available round the clock. Three fully functional operating suites equipped with L. F. airconditioning shadowless operating lights, electronic cardiac tables, heart lung machines and accessories, infusion pumps, multichannel monitors, defibrillators and advanced micro vascular instruments, guarantee the best cardiac surgical treatment to the patient at par with international standards. The division extends its services to significant number of international patients. A substantial number of patients from Iraq, Afghanistan, Pakistan, Bangladesh, Nepal, Ethiopia, Nigeria and Sri Lanka have availed of our services in addition to a few from USA, UK and Europe. A 23 bed dedicated and fully equipped intensive care (adjacent to the operating units) provides 1:1 nursing care by specially trained nurse’s day & night. While the Intensive care is being actually attended by Registrars and residents, what sets Apollo CTVS ICU apart from other is the supervisory vigil kept by the dedicated team of anesthesiologists.

    Spectrum of Services Offered

    A. Coronary Artery Bypass Graft Surgery:

    The department was one of the pioneers of beating heart surgeries in 1999 and since 2000, this method continues to be the procedure of choice of surgical revascularisation of coronary artery disease. Even though, this procedure does not require cardiopulmonary bypass, all the three operating suites are equipped with heart lung machine and Intra aortic balloon pumps. The homolougus blood transfusions are minimal and can be avoided totally in large number of cases when cell saver is used. In addition to primary CABGs, the centre is known for its proficiency in REDO CABG and combined procedures like AVR + CABG, MVR + CABG and carotid endarectomy. The internal mammary arteries (Left/Right/Bilateral) are the most preferred conduits for CABG except Bilateral IMA is avoided in insulin dependent in diabetics. The radial artery is the next best conduit. Aorto coronary by pass is the usual mode of surgical revescularisation, but LIMA – RIMA Y graft is often used in younger patients for Total Arterial Revascularisation. Acute and urgent surgical intervention maybe required to treat acute coronary syndrome complicated by left main stenosis, Post infarction VSD, Impending Cardiac Rupture or Acute Mitral Regurgitation and the unit gears up 24/7 to envisage these life saving operations with good outcomes. Valuable adjuncts like a large number of ventilators and Intracardiac balloon pumps help in salvaging these very sick patients. Redo CABG are readily accepted and more than 160 have been carried.

    B. Valve Surgery:

    All valve surgeries are undertaken with confidence and both repairs and replacements are done with good outcomes. Both Prosthetic (metallic) valve substitutes and Bio-prosthetic (tissue) valve substitutes are available. The surgeons are fairly experienced in carrying out valves repairs whenever possible and endeavor to preserve the subvalvar apparatus during mitral valve replacements. Intra –operative Transesophagial echocardiography is available whenever needed.

    C. Aneurysm Surgery:

    Aortic aneurysms are handled with confidence. Elective and Emergency surgeries are undertaken to take care of aortic dissections day or night. More than 140 aortic root replacements (Bentall operations) have been done with 90-95% success.

    D. Congenital Heart Defects:

    The entire gamut of congenital heart defects are accepted for repairs. Neonatal arterial switch operations for Transposition are done regularly. Other intra cardiac palliative and corrective surgeries are offered for complex congenital defects. Epicardial chocardiography is available for assessing efficiency of procedures carried out.

    E. Thoracic Surgery:

    All thoracic surgical procedures like lung resections decortications, volume reduction surgery are undertaken by dedicated team of Thoracic Surgeons. VATS (Video Assisted Thoracoscopic Surgery) is also available.

    F. Vascular Surgery:

    Peripheral vascular disease, abdominal aortic aneurysm and carotid artery disease are appropriately handled by dedicated surgeons when indicated.
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