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Cardiac Surgery

Procedure overview

Cardiac procedures are performed using a sternotomy approach, or a minimally invasive approach.  A sternotomy involves splitting the entire breastbone, cutting the skin over your breastbone (sternum) and then cutting through your sternum. When your surgery is finished, the doctor reconnects your sternum most likely using wire, which will stay in your body even after your sternum has healed.[1]

Minimally invasive cardiac surgery includes a variety of operations performed through incisions that are substantially smaller and less traumatic than the standard sternotomy. Minimally invasive incisions measure about 3 to 4 inches compared to 8 to 10 sternotomy incisions. Specialized handheld and robotic instruments are used to project the dexterity of the surgeon’s hands through these small incisions in performing the operations.[2]

Robotic-assisted cardiac surgeries are minimally invasive procedures and most frequently include coronary artery bypass graft (CABG), and mitral valve replacement. Coronary artery bypass graft (CABG) is used to treat the blocked or narrowed arteries using a piece of healthy blood vessel from elsewhere in your body to bypass the blocked portion of the coronary artery.  Blood vessels, or grafts, used for the bypass procedure may be pieces of a vein from your leg or an artery in your chest. An artery from your wrist may also be used. Your doctor attaches one end of the graft above the blockage and the other end below the blockage. Blood bypasses the blockage by going through the new graft to reach the heart muscle.[3]

Mitral valve repair and mitral valve replacement are procedures that may be performed to treat diseases of the mitral valve — the valve located between the left heart chambers (left atrium and left ventricle).[4]

Figure 1. Open vs Robotic, Port Placement for Cardiac Surgery

Learn more about what robotic assisted surgery is and how surgeons use the technology here.


Potential Benefits​

Reported benefits of robot assisted cardiac surgery include:

  • Patients may experience lower rates of pneumonia or wound infection compared to conventional, and shorter intensive care unit length of stay compared to conventional CABG or minimally invasive CABG methods.[6,7]
  • Patients may have less postoperative pain, renal failure, transfusion, reoperation for bleeding, stroke and hospital length of stay compared with other methods of CABG.[6]

Additional Patient Resources

Visit the the Heart and Stroke Foundation of Canada website for more informational about the disease, diagnosis, treatment options and support available.

Community Groups

Educational Videos

Dr. Gianluigi Bisleri on RAS Cardiac surgery in Ontario

Innovation at London Health Sciences

Dr. Denis Bouchard on Robotic Surgery (French)

Dr. Randy Moss and his patient Kelly describe their successful experience with robot assisted CABG

This Mayo Clinic animation shows how, using robotic technology, surgeons can repair mitral valve prolapse [US Content]

Curious about robotically assisted heart surgery? Learn about the the essentials with this richly visual three-minute video. [US Content]

 

Risks & Considerations

Not everyone is a candidate for robotic assisted procedures, and other treatment options may be available and appropriate. Only a doctor can determine whether robotic assisted surgery is appropriate for a patient’s situation. Surgery of any form contains risks and it is important to discuss risks with your provider. Patients and doctors should review all available information on both non-surgical and surgical options in order to make an informed decision.

Patients have also developed support areas where they are able to speak with each other about the surgery, their experiences, and any issues that they have faced during their treatment. To learn more check out the additional resources above or visit the community section of this website.

[1] https://myhealth.alberta.ca

[2] https://www.hopkinsmedicine.org

[3] https://www.hopkinsmedicine.org

[4] https://www.mayoclinic.org

[5] Wang, N., Zhou, J. J., Phan, S., Yan, T. D., & Phan, K. (2015). Robot-assisted Hybrid Coronary Revascularisation: Systematic Review. Heart, Lung and Circulation, 24(12), 1171–1179. https://doi.org/10.1016/j.hlc.2015.06.818‌

[6] Hammal, Fadi, et al. “Robot-Assisted Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis of Comparative Studies.” Canadian Journal of Surgery, vol. 63, no. 6, 6 Nov. 2020, pp. E491–E508, 10.1503/cjs.013318. [7] Gong, Wenhui, et al. “Robot-Assisted Coronary Artery Bypass Grafting Improves Short-Term Outcomes Compared with Minimally Invasive Direct Coronary Artery Bypass Grafting.” Journal of Thoracic Disease, vol. 8, no. 3, Mar. 2016, pp. 459–468, 10.21037/jtd.2016.02.67