Our Summary

This research paper investigates whether minimally invasive heart surgery is more cost-effective than traditional open-heart surgery (median sternotomy) for treating problems with the heart’s mitral valve. The researchers looked at 51 studies and picked the 7 best ones to answer this question. None of these studies were randomized controlled trials, which are generally the gold standard in medicine, but the conclusions were still deemed valuable.

The studies compared different types of minimally invasive surgeries to the traditional surgery. Some of these included a small incision in the chest (minithoracotomy), using a special port to access the heart, or using video assistance during surgery.

The results showed that these minimally invasive surgeries resulted in lower costs for heart imaging and lab tests, less use of blood products, fewer infections, quicker recovery times, shorter hospital stays, less need for rehabilitation, and fewer patients having to be readmitted to the hospital within a year of surgery.

Therefore, the researchers concluded that minimally invasive surgery for mitral valve issues is not only safe and effective, but it also saves more money compared to traditional open-heart surgery.

FAQs

  1. What types of minimally invasive surgeries were compared to traditional open-heart surgery in the studies?
  2. What benefits did the study find in favor of minimally invasive heart surgery over traditional open-heart surgery?
  3. Were any randomized controlled trials included in the research for this paper?

Doctor’s Tip

A doctor might advise a patient undergoing sternotomy to follow post-operative care instructions carefully to ensure proper healing and minimize complications. This may include avoiding heavy lifting, following a prescribed medication regimen, attending follow-up appointments, and engaging in recommended physical therapy or rehabilitation exercises. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support recovery and overall heart health.

Suitable For

Patients who are recommended sternotomy typically have more complex mitral valve issues that cannot be effectively treated through minimally invasive techniques. This may include patients with severe mitral valve regurgitation, mitral valve stenosis, or other structural abnormalities that require a more extensive surgical approach. Additionally, patients who have had previous heart surgeries or other medical conditions that may complicate the surgery may also be recommended sternotomy. Ultimately, the decision on whether to recommend sternotomy or a minimally invasive approach will depend on the individual patient’s specific condition and needs.

Timeline

Before sternotomy:

  • Patient undergoes diagnostic tests (such as echocardiogram, MRI, or CT scan) to determine the extent of heart valve damage.
  • Patient may undergo medical management or other treatments to alleviate symptoms before surgery.
  • Patient meets with a cardiac surgeon to discuss treatment options and the risks and benefits of surgery.
  • Patient may undergo preoperative testing (such as blood tests and chest x-rays) to ensure they are fit for surgery.
  • Patient may need to make lifestyle changes or stop certain medications before surgery.

After sternotomy:

  • Patient is prepped for surgery, which involves anesthesia and positioning on the operating table.
  • Surgeon makes an incision in the chest through the sternum to access the heart.
  • Patient is placed on a heart-lung bypass machine to circulate blood during surgery.
  • Surgeon performs the necessary repairs or replacements to the mitral valve.
  • Patient is closed up and monitored in the intensive care unit (ICU) for recovery.
  • Patient is transferred to a regular hospital room for further monitoring and rehabilitation.
  • Patient undergoes postoperative care, including pain management, physical therapy, and medication management.
  • Patient is discharged from the hospital and continues recovery at home, with follow-up appointments scheduled with their healthcare team.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sternotomy include:

  1. What is sternotomy and why is it being recommended for my condition?
  2. What are the potential risks and complications associated with sternotomy?
  3. Are there any alternative surgical approaches, such as minimally invasive surgery, that may be suitable for my condition?
  4. How does the recovery process differ between sternotomy and minimally invasive surgery?
  5. What are the long-term outcomes and success rates for sternotomy compared to minimally invasive surgery?
  6. Will I need any specific post-operative care or rehabilitation after undergoing sternotomy?
  7. How soon can I expect to return to normal activities after undergoing sternotomy?
  8. Are there any specific lifestyle changes or precautions I should take after undergoing sternotomy?
  9. How can I best prepare myself physically and mentally for undergoing sternotomy?
  10. Are there any additional resources or support groups available for patients undergoing sternotomy?

Reference

Authors: Santana O, Larrauri-Reyes M, Zamora C, Mihos CG. Journal: Interact Cardiovasc Thorac Surg. 2016 Jan;22(1):97-100. doi: 10.1093/icvts/ivv269. Epub 2015 Oct 3. PMID: 26433974