Minimally invasive cardiothoracic surgery (MICS) has demonstrated excellent results and has grown in reputation. The benefits of minimal access surgery are; minimum pain reduced surgical trauma, no major scar, at the most 5-7 days of hospital stay & benefits include improved quality of life and early back to work/active life. Innovations in perfusion technology, improvements in transthoracic echocardiography, the refinement in surgical tools and use of robotic technology, have made cardiac surgery to transfer towards minimum invasive methods. The published literature on MICS long-term outcomes, suggest that, cardiac operations that have traditionally been performed through a median sternotomy can be performed through a variety of minimally invasive approaches with equivalent safety and durability.
A 74-year-old gentleman has had four times coronary artery bypass surgery. Following this, he received ablation therapy for irregular heart rate. He later underwent Mitra clip application for mitral valve leak! He was breathless, weak and could barely walk few meters.
Unfortunately, despite the earlier three attempts to fix his mitral valve using a Mitra clip, the leak across the mitral valve continued, leading to liver and kidney dysfunction, and weakening of the heart function (EF 32%).
Performing 5th-time heart surgery with underlying patent bypass grafts has significant challenges and is associated with very high chances of surgical complications & possible mortality. Such patients are usually deemed inoperable and conservatively managed with heart failure medications which give poor results compared to mitral valve surgery.
Devastated by his symptoms the patient was looking for ways to get rid of them, Dr. Ravi Ghatnatti and his team offered him keyhole mitral valve surgery. After thorough discussion and evaluation, the team lead by Dr. Ravi Ghatnatti successfully performed a beating heart keyhole mitral valve replacement. Patient withstood the surgery very well & removed ventilator support within 4 hours, and he was kept in ICU for one day and discharged from hospital on 5th day.
Dr. Ravi is of the opinion that, any patient with previous heart surgery is a complex case to operate due to a stuck right heart chamber to the entry site, adhesions, functioning graft injury, and challenges with arresting and preserving the heart. Even in the best hands, four times previous heart surgeries increase the operative death risk to 10-15%. The option of keyhole surgery in this patient made a huge difference. All these risks were mitigated through a keyhole approach using special techniques by our experienced team in the UK. Keyhole mitral valve surgery can be offered in any subset of patients which will help them recover faster and get discharged early due to less surgical trauma.
(Dr. Ravi Ghatnatti, M.Ch (Cardiac Surgery) is a young promising Cardiac Surgeon is on study leave from KLES Dr. Prabhakar Kore Hospital, Belagavi is pursuing Masters in Minimum Invasive Cardiac Surgery (Key Hole surgery) & Video Assisted Thoracic Surgery from Blackpool Victoria Teaching Hospitals NHS foundation trust, Blackpool, Lancashire, United Kingdom)
Dr. Ravi Ghatnatti can be contacted on: ravighatnatti81@gmail.com
