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Heart Surgery

Q: In robot-assisted heart surgery, does the surgeon perform the surgery, or does the robot?
A: The Da Vinci surgical robot is used in a variety of heart operations; specifically, coronary artery bypass, mitral and tricuspid valve repair and replacement, excision of cardiac tumors, and repair of certain cardiac defects. It is a tool that the surgeon combines with other techniques to perform a minimally invasive operation. The robot has no autonomy, and is always under the control of the surgeon.

The surgical robot allows the surgeon to work in confined spaces such as the chest cavity in front of the heart (for CABG) or the left atrium (for mitral valve repair) with minimal incisions to access the space. The robot enhances the surgeon's vision by providing a magnified 3D image, and the surgeons hand movements are translated into finely-graded motion of the robot instruments which have 6 degrees of movement, which is more precise than the human hand.

Without the surgeon to interpret the images and to provide the desired movement of the instruments, the robot is a million dollar coat rack.

Answered by Frank C. Seifert, MD. Dr. Seifert is a cardiothoracic surgeon and associate professor of surgery. He is director of minimally invasive surgery.

Q: Can my mitral valve be repaired?
A: Yes. More than 90% of mitral valves can be repaired versus conventional mitral valve replacement. This will allow you to preserve your own tissue and preserve your heart function. Additionally, you will have less risk of infection and more long-term durability and improvement in your symptoms over the course of your lifetime.

Q: Can my valve be repaired with a minimally invasive procedure?
A: Yes. The majority of all isolated valve procedures can be done with a small incision. This will allow quicker recovery, less pain, and faster return to work.

Q: Can the robot be used to fix my valve?
A: Yes. In mitral valve surgery, we can use the latest in robotic technology to repair your valve. This allows the surgeon improved dexterity, visualization, and repair techniques to give you the best mitral valve repair. It also allows for a faster recovery, less pain, and quicker return to work.

Q: What are the risks of valve surgery?
A: The risks for isolated mitral valve repair or aortic valve surgery are minimal, and are similar to any surgery. They include the risk of bleeding, infection, pneumonia, organ failure, stroke, and even a small risk of death. In general, these complications are expected in less than 5% of patients. During your consultation, your surgeon can tell you what your specific risks are.

Q: How long will it take before I feel well after valve surgery?
A: For most patients who have valve surgery, it takes about 2-3 weeks to feel well, while some healing and recovery occur months thereafter. Actually, most patients typically feel better than before surgery once their valve is repaired. This should give you better quality of life.

Q: My doctor says I have heart failure. Do I need one of those new artificial heart devices?
A: Heart failure is classified from Class 1 (mild symptoms controlled with medication) to Class 4 (severe symptoms despite maximal medical treatment). Heart transplantation is the gold standard treatment for Class 4 heart failure, but is limited because of a shortage of donors and concomitant patient features such as significant kidney disease or history of cancer. The left ventricular assist device (LVAD) was developed initially as a "bridge" to help patients accepted for transplant survive until they received a new heart.

In February 2010 the FDA approved the LVAD called HeartMate 2 as "destination therapy," so that appropriate patients with Class 3 or 4 heart failure, who are ineligible for a transplant, might be supported indefinitely by the device. It is piggy-backed onto the left ventricle, the main pumping chamber of the heart. The blood pump sits in a pocket under the heart and pumps blood up to the aorta, the main artery exiting the heart. All is contained within the body except for the driveline, an electrical cord, which is connected to a power source. This may be a plug-in power-based unit, when the patient is stationary, as when in bed at night, or a battery pack which allows freedom of movement.

Studies show a significant improvement in quality of life with the HeartMate 2 compared to conventional medical treatment.

Answered by Allison J. McLarty, MD. Dr. McLarty is a cardiothoracic surgeon and associate professor of surgery.

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