With Sarasota Memorial Cardiac Surgeon Jonathan Hoffberger, MD
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Cardiac care, treatment and surgical options are continually evolving. To get some insight into the latest options in heart surgery, Healthe-Matters editors talked with Dr. Jonathan Hoffberger, a cardiac surgeon and medical director of minimally invasive cardiac surgery.
Q: What is “minimally invasive cardiac surgery”?
Minimally invasive cardiac surgery is open-heart surgery done through a small incision. Traditionally, open-heart surgery is done through an 8- to 12-inch incision in the center of the chest. We do the same operation, but through two small incisions: a small, keyhole incision on the right side of the chest and a small incision in the groin area.
Q: Who's a candidate for minimally invasive valve repair or replacement surgery?
Most people who need valve operations are candidates for minimally invasive valve surgery. We can do aortic valve surgery, mitral valve surgery and tricuspid valve surgery, all through a small incision. We also can do other procedures that go along with those valve operations, procedures like ablation for atrial fibrillation or repairing holes in the heart for atrial septal defects.
Q: What are some benefits of minimally invasive valve repair or replacement?
Many of the benefits of minimally invasive (MI) procedures are a result of the small incision(s). One benefit would be improved cosmetic results: Instead of having an 8- to 12-inch incision on your chest, the surgery is done through a side incision that’s only about 3 inches long. More importantly, that smaller incision means less blood loss during surgery, reduced pain and earlier discharge from the hospital. Typically, MI patients are getting out of the hospital three to five days after surgery, which is similar to that of an open-heart operation done through an open incision. However, MI patients return to normal daily activities much sooner. With an open-heart surgery, return to normal activities is usually about six to 12 weeks; with minimally invasive, it’s more like two to four weeks of recovery.
Q: Do all heart surgeons perform minimally invasive surgery?
No. Most heart surgeons aren't taught minimally invasive open-heart surgery as a resident, so they don't get practice doing it. Then, when they come out of residency and are operating on people, they don't have anybody teaching them the procedure.
Also, minimally invasive procedures can be technically difficult, and they are a departure from what most learn during residency. Typically, when you do it through a big, open incision, you can get your hands inside to deal with any problems that arise. With minimally invasive cardiac surgery, you're working with long, single-shafted instruments, and it's more difficult to control a situation should you get into one. The idea is not to get into a situation, and that requires experience.
At Sarasota Memorial Hospital, we perform many minimally invasive procedures. Naturally, you get better and better at it over the years. Now we have a streamlined program that's running beautifully, and our patients are all doing really well. When you have a heart care program that doesn’t do many minimally invasive procedures, the surgeons can’t get that constant experience.
Q: Why should someone consider minimally invasive surgery?
Reason No. 1 is that recovery time is much quicker. Instead of it being a six- to 12-week recovery, it’s two to four weeks. The second reason is that it’s safe. Our outcomes in minimally invasive cardiac surgery are the same as — or in many cases, better than —traditional open-heart operations.
Q: If a patient has been told that traditional open-heart surgery is the only option or that surgery is impossible, is it worth getting a second opinion?
I think it's very important to get second opinions. It's important to just ask questions and look further beyond what you're told the first time.
A lot of surgeons who don't do minimally invasive open-heart surgery will not offer patients minimally invasive cardiac surgery as an option. We get second opinions in a lot of different aspects in our life for many reasons, and having open-heart surgery is a very important decision to make.
I would recommend that if you need a valve operation done, it takes no time at all to call and make an appointment with somebody who can do a minimally invasive surgery. In the end, it still may not be an option for you, but then again, it might.
For more information on minimally invasive heart surgery options, please visit smhheart.com.
A board-certified cardiovascular-thoracic surgeon, Dr. Jonathon Hoffberger serves as medical director of minimally invasive cardiac surgery. He has performed thousands of cardiac and thoracic procedures, including coronary revascularization, minimally invasive cardiac surgery, mitral valve repair, complex multi-valve operations, high-risk operations, thoracic vascular reconstructions and cancer surgery.