n Minimally Invasive Cardiac Surgery (MICS) at Excela Health n Robotic Pulmonary Segmentectomy at

Minimally Invasive Cardiac Surgery (MICS) at Excela Health

Heart surgery is a major complex procedure. However, with the evolution of new technologies, it has become less invasive and provides clinical options that are of material benefit to both the surgical team and the patient. These advances are now available through a very robust and accomplished cardiac surgery program at Westmoreland Hospital.

Traditionally, heart surgery has been performed through an incision of about eight inches down the middle of the chest (Fig 1). Since the sternum is also completely divided, it takes time for the bones to heal.

This, in turn, gives rise to an elongated period of time to fully return to daily life (driving, carrying heavy loads, etc.). Additionally, rare complications such as mediastinitis can occur, which can be an emotional burden on the patient from a cosmetic standpoint as well.

We are pleased to announce that at Excela Health Westmoreland Hospital, our cardiac surgery team has been providing MICS procedures since September 2019.

We perform valve repair and replacement for patients with valvular diseases such as aortic stenosis and mitral regurgitation through a small, partial sternal incision or a small, right intercostal thoracotomy (Fig 2).

Fig 1 Traditional median full sternotomy

FIg 2 Right mini-thoracotomy for mitral valve procedure The skin incision is about 2.5 inches in length and preserves the sternum, creating the following advantages:

n Less infection n Less anesthesia time n Less bleeding and blood transfusion n Faster recovery and discharge n Faster return to full function n Cosmetic advantages The introduction of MICS allows for the same surgical outcomes as traditional methods, made possible by advances in heart- lung machine technology, the introduction of specialized MICS tools (Fig 3), and the use of endoscopes to improve visibility (Fig 4).

In addition, we have been occluding the left atrial appendage with the Atriclip device in patients who are not suitable for the trans-catheter Watchman procedure, with a left thoracoscopic approach using three incisions .5 to 1 inch in length. This procedure provides an attractive MICS intervention for certain afib patients desiring to eliminate their need for a lifetime regimen of blood thinners.

Not all patients are suitable for a MICS procedure depending on the body habitus, complexity of the cardiac procedure, and other clinical factors. Thorough pre-operative examinations and selection of patients have resulted in superb outcomes of cardiac surgery at Excela in both our MICS and traditional approaches.

Fig 3 MICS instruments allow access to the heart through small incision

Fig 4 Mitral valve repair using endoscope with excellent visibility