Easing the Broken Heart: The Promise of Minimally Invasive Heart Surgery

WORDS LIM TECK CHOON

FEATURED EXPERT PROFESSOR DR SHAHRUL AMRY HASHIM Consultant Cardiothoracic Surgeon Damansara Specialist Hospital 2

When people hear the words ‘heart surgery’, fear often grips them. Images of cracked chests and lengthy recoveries can be terrifying.

However, according to consultant cardiothoracic surgeon Professor Dr Shahrul Amry Hashim, there is a revolutionary approach that’s changing how we think about heart procedures: minimally invasive heart surgery.

WHAT MAKES THIS SURGERY DIFFERENT?

What we consider traditional heart surgery involves splitting the breastbone and making a large incision.

In contrast, minimally invasive heart surgery takes a gentler approach. Professor Shahrul explains that surgeons now make a much smaller cut—each cut usually just 4 to 6 centimeters—typically on the side of the chest, without cutting through the breastbone.

“The surgeon will be able to access the heart through the spaces between the ribcage,” he adds.

Professor Shahrul shares that minimally invasive techniques can address three of the most common heart surgeries:

• Heart bypass surgery. Performed when there is a blocked blood vessel; it creates a new route for blood to flow around the blockage.
• Heart valve repair or replacement. Damaged heart valves can prevent or stop proper flow of blood from the heart to the rest of the body and back again.
• Repair of holes in the heart. Hole in the heart, or atrial septal defect, can lead to abnormal blood flow in the heart and disrupt the heart function.

THE MINIMALLY INVASIVE APPROACH

Professor Shahrul reveals that the development of certain special tools makes minimally invasive heart surgery possible.

• An endoscope—a thin tube with high-definition camera attached to one end—can be used by the surgeon to visualize properly the structures of the heart through the tiny incisions made in the chest.
• Specialized long surgical instruments allow the surgeon to perform delicate surgical procedures on the heart from a distance.

Minimally Invasive Heart Surgery

There are two main types: thoracoscopic surgery and robot-assisted surgery.

Thoracoscopic surgery. Generally, the procedure is as follows:

1. The surgeon makes small cuts into the patient’s chest.
2. An endoscope is inserted through the incision to view the heart.
3. Using the visualization of the endoscope as a guide, the surgeon will use specialized long surgical tools to perform the necessary surgical treatments through the small incisions.
4. Once the surgery is completed, the surgeon will stitch up the incisions.

Robotics-assisted surgery. Similar to the above, but this time around, the surgeon uses robotic arms to perform the surgery through the incisions.

NO BIG CUTS NEEDED & OTHER ADVANTAGES OF THIS SURGERY

According to Professor Shahrul, there are several notable benefits of such surgery to patients:

• Significantly reduced infection risk
• Less bleeding
• Faster healing
• Reduced pain
• Quicker return to normal activities; providing that everything goes well, one can resume driving and work within 2 to 3 weeks after the surgery.
• Shorter period of follow-up with the doctor.

The above benefits are especially significant to people that have existing health conditions that can slow down their healing and increase the risk of infection, such as people with diabetes. Older people with osteoporosis and other weak bone conditions can also benefit, as minimally invasive surgery does not exert trauma onto the bones of the chest area.

Additionally, there are some psychological benefits. The smaller incision and preservation of chest structure dramatically reduce patient anxiety. As Professor Shahrul notes, many patients become ‘braver’ to undergo heart surgery after they understand they won’t have their chest split open!

IS THIS SURGERY SUITABLE FOR EVERY PATIENT THAT NEEDS TO UNDERGO HEART SURGERY?

While almost all patients can undergo this procedure, there are some rare exceptions.

A notable example, Professor Shahrul points out, is when a patient must undergo emergency heart surgery. Because time is of an essence, open heart surgery may be performed instead.

WHAT IS IN THE FUTURE FOR MINIMALLY INVASIVE HEART SURGERY?

The next frontier to explore is robotic heart surgery.

While not implemented in Malaysia at the time of writing, Professor Shahrul is optimistic about it.

He reveals that there are plans to introduce robotic techniques at several hospitals in the coming year. This technology promises even greater precision and potentially improved outcomes.

A HOPEFUL OUTCOME

For patients facing heart surgery, Professor Shahrul assures them that minimally invasive techniques offer more than just a medical procedure—they offer peace of mind.

As Professor Shahrul observes, when patients understand they can have heart surgery without major trauma, their psychological healing begins even before the physical healing.

The future of heart surgery is here, and it’s smaller, smarter, and gentler than ever before.