MICS: A boon in the world of cardiac surgery

Who Needs a Cardiac Surgery?

Patients who either have a congenital heart ailment or an adult age-related problem, like coronary artery blockage or leaky and disfigured valves, need cardiac surgery. These are often patients whose cardiac problems can no longer be contained or managed with medicines alone. The need is urgent today, more than ever, because of increasing lifestyle-related disorders, which are constantly on the rise, and with current trends according to which, by 2030, India would be the world capital of diabetes and heart-related problems, many of which would require surgery. The age of people getting operated has come down, and now, we often encounter a population in their 4th and 5th decade of life, coming to us for cardiac surgery.

Common Conditions which Require Cardiac Surgery

congenital defects like Atrial Septal defects or Ventricular Septal defects (hole in the heart) or Tetralogy of Fallot (Blue Baby), or people who acquire Coronary Artery Disease (blockage of an artery) or Valvular Defects (Stenosis or narrowing down and regurgitation or leaky valves). All this was earlier done by the traditional open approach with long recuperation, but the same spectrum can now be done using Minimal Invasive Cardiac Surgery with shorter hospital stay and quicker return to a normal life.

How a Patient Benefits from a Cardiac Surgery

Unlike medical treatment alone, or in combination with interventions where the relief is temporary or palliative in nature, suitable as a bridge therapy or for old frail people, cardiac surgery addresses the problem and is often looked upon as a permanent solution and destination therapy, having developed over the earlier part of the century and gone on to save millions of lives. Today, the benefits of a century of research and rigor can be put with the added benefit of MICS (which became possible with the development on computers, digital video and photography, and imaging capabilities along with highly ergonomic instruments), and the problem of operating on old frail people and quicker recovery from surgery (the advantages of interventional techniques) have been addressed with the authority of a surgical repair. Our center operates on octagenarians as old as 86 to li’l ones as tiny as a few days or a month old, and have successfully carried out about 40,000 surgeries, since our inception 18 years ago.

MICS is an acronym for Minimally Invasive Cardiac Surgery

It involves surgery with smaller incisions (cuts) which are much smaller compared to the traditional sternotomy or thoracotomy approaches and results in less blood loss, better cosmesis, faster healing and early return to daily activities. Over the past 3 decades, with improvement in instrumentation and better computer-aided imaging, better digital high-precision cameras, and a paradigm shift in the field of robotics and ergonomic digital instrumentation, MICS has been able to see the light of day. It has become a reality today, extending its arms to cover almost the entire aspect of cardiothoracic surgery. The thoracic arm is identified as VATS (Video-Assisted Thoracoscopic Surgery) and the cardiac arm as MICS (Minimally Invasive Cardiac Surgery).

Operations which can be performed with MICS:

MICS has been used to perform both epicardial (closed heart) operations like coronary artery bypass grafting, as well as endocardial (open heart) procedures like adults aortic and mitral valve surgeries, paediatric (congenital) malformations like Atrial Septal Defect (ASD) and Patent Ductus Arteriosus (PDA).

Also, successful surgeries have been carried out in the direction of performing complex congenital surgeries using the MICS       approach, which makes it easier for the child to cope up with the stress of the surgery.

How is MICS different?

MICS is different in that an entirely different set of surgical instruments has to be used. Also, the operation theatre has to be a hybrid one, and have capabilities of imaging and using videoscope-assisted and/or robot-assisted equipments. The entire surgical team, from the surgeon to the assistant surgeon, the nurse, and the anaesthetist, have to be trained to undertake surgery. Moreover, the surgical curve of learning the steps is often long and very steep. But with the case load that we get to handle, our centre is perhaps the only centre in Eastern India to offer the entire spectrum of MICS and VATS to the populace. There are many more firsts in Minimal Invasive Cardiothoracic Surgery that we have performed.

Minimally Invasive Surgey (MIS) is fast gaining popularity, and rightly so. It has many advantages over standard surgical approaches, developed primarily to reduce trauma to the chest wall tissues. Therefore, more and more surgeons, as well as patients, are opting for MIS for the treatment.

The benefits of minimally invasive cardiac surgery are as follows:

Shorter Hospital Stay: MIS involves a hospital stay of 3 to 5 days, as compared to a traditional sternotomy-based cardiac operation, which involves a stay of 5 to 7 days.

Fewer Physical Restrictions: Patients undergoing standard incision cardiac operations are restricted from driving an automobile, or lifting objects weighing more than 5 pounds, while patients undergoing minimally invasive cardiac surgery are not subject to such restrictions.

Shorter Recovery Time: The recovery period after minimally invasive operations span 2 to 4 weeks, as compared to 6 to 8 weeks for standard sternotomy-based cardiac operations.

Smaller Incision: A smaller cut means a smaller scar, which results in better cosmesis. This is often a priority for females, owing to the social stigma pertaining to surgical scars. A smaller cut also entails lesser surgical trauma, making it suitable for septuagenarians who may be in need of a life-saving cardiac procedure.

Minimal Blood Loss: This means a reduced need for blood transfusion, which, in turn, means less immunosuppression, lesser chances of infection and a lower risk of transfusion-related complications.

Less Pain: Due to the small cut, less blood loss and reduced recovery time, the patient has to endure much less pain.

At RN Tagore Hospital, Kolkata, 24/7 emergency services are available for all cardiac-related problems.

Dr. Lalit Kapoor, Senior Consultant, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata

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