Surgical Treatment Options

If alternative treatment methods such as lifestyle changes, medications or medical procedures have not alleviated your symptoms or improved your heart condition, heart surgery may be an option. If your doctor has recommended surgery to treat your heart condition, you'll want a cardiac surgeon and a care team with knowledge and expertise in a wide range of procedures.

Leveraging state-of-the-art surgical techniques to achieve the most optimal care for heart disease, Cedars-Sinai provides expertise in all aspects of minimally invasive and traditional surgical cardiac care for children, adolescents and adults. As a result, our patient’s experience low incidence of complications after cardiac surgery, resulting in less pain, shorter hospital stays, faster recovery and less anxiety. Our teams are in a unique position to provide comprehensive, individualized care for each patient.

Minimally Invasive Cardiac Surgery

New techniques in heart surgery have allowed many common open-heart operations to be performed using less invasive methods. Minimally invasive cardiac surgery is a technique that reduces the size of the incision(s) and damage to surrounding anatomy needed to treat a heart condition. Unlike traditional open heart surgery, where a large, single cut is made through the chest wall (breastbone and surrounding muscles), minimally invasive surgery allows surgeons to use highly specialized and often smaller tools and lighted cameras to gain access to the areas requiring treatment.

Conditions Treated

Minimally invasive cardiac surgery is often used to treat a range of conditions related to:

  • Aortic Disease
  • Atrial Fibrillation
  • Atrial Septal Defect
  • Cardiac Tumors
  • Coronary Artery Disease
  • Congenital Heart Disease
  • Valvular Heart Disease

Your cardiac care team will work together to determine the best approach to treating your heart condition. They will collectively and carefully evaluate factors such as your age, medical and social history, your specific heart condition and other tests before determining if you are a candidate for minimally invasive cardiac surgery.

Find an Expert/Need a Second Opinion?

The Cardiac Surgery Program at Cedars-Sinai provides expert care and innovation to bring you optimal results. If you have questions, need a second opinion or want to find out if your heart condition can be treated with minimally invasive surgery, please contact our team.

Types of Surgeries

Smidt Heart Institute cardiac surgeons use advanced procedures and technologies to perform the complete range of minimally invasive surgeries for patients with heart disease.

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is a surgical treatment for coronary heart disease that is a less invasive method of coronary artery bypass surgery (CABG).

MIDCAB is a form of off-pump coronary artery bypass surgery (OPCAB), performed "off-pump"—without the use of cardiopulmonary bypass (the heart-lung machine). MIDCAB differs from OPCAB in the type of incision used for the surgery; with traditional CABG and OPCAB a median sternotomy (dividing the breastbone) provides access to the heart; with MIDCAB, the surgeon enters the chest cavity through small incisions.

Minimally invasive heart valve surgery uses smaller incisions to repair or replace heart valves. Minimally invasive valve surgery can only be done in certain patients. This type of surgery cannot be done in patients who:

  • Have severe valve damage
  • Need more than one valve repaired or replaced
  • Have clogged arteries (atherosclerosis)
  • Are obese
  • Have had previous heart surgeries

Two of the safest minimally invasive procedures commonly performed at Cedars Sinai are the MitraClip Procedure and the Transcatheter Aortic Valve Replacement

Learn more these procedures and the Valvular Heart Disease Program

Maze surgery (also called the maze procedure) treats atrial fibrillation by creating a maze of new electrical pathways so that electrical impulses can travel easily through the heart.

The maze procedure is usually done after a person with atrial fibrillation has had poor results from medications or other types of treatment. It was designed to treat people who have chronic, intermittent atrial fibrillation.

Minimally invasive maze surgery doesn't require a large incision in the chest and doesn't require a heart-lung machine during surgery. Patients who have minimally invasive maze surgery usually stay in the hospital only two to three days compared to hospital stays of 10 to 12 days required on average after traditional open heart maze surgery.

Generally, recovering from maze surgery takes six to eight weeks. Some patients experience atrial fibrillation again within the first three months after surgery. However, this type of atrial fibrillation is generally more responsive to medications prescribed to control abnormal heart rhythms. After three months, only three patients out of a 100 who have the maze surgery experience more atrial fibrillation.

The maze procedure is extremely useful for patients with atrial fibrillation who are having other heart surgeries, including coronary bypass surgery or mitral valve surgery.

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that uses small incisions and eliminates the need to spread the ribs.

It is used to treat patients who were born with a problem involving the heart or nearby blood vessels. Known as congenital heart disease, the condition affects approximately eight children in every 1,000 births. Defects can show up at birth, as the child grows or even in adulthood.

VATS is performed through a one-inch incision. The surgeon is aided by a miniature camera inserted through one of three quarter- to half-inch incisions. While VATS is not painless, it hurts less than a large thoracotomy.

The benefit of using VATS is that, in many cases, surgery takes less than an hour and the patient can leave the hospital 24 hours after surgery. Also the technique can be used on patients weighing as little as two pounds.

Robotic surgery is among the many innovations used at Cedars-Sinai for advanced minimally invasive surgery. This approach improves a surgeon's ability to perform complex minimally invasive surgery and makes possible microsurgical procedures that conventional surgical techniques cannot achieve.

The robotic surgical system consists of three or four robotic arms, one to position the endoscope and the remainder to hold surgical instruments. The surgeon can precisely control the surgical instruments with his hands while the positioning of the endoscope is voice controlled. A video display of the high-definition endoscopic image allows the surgeon to see inside the patient's body in far greater detail. This system improves the surgeon's precision and ability to manipulate instruments in small spaces, helping to make the procedures even less invasive. 

Direct Coronary Artery Bypass

Robotic Minimally Invasive Direct Coronary Artery Bypass (RMIDCAB) surgery uses the da Vinci tele-robotic system. The system consists of a robotic system at the bedside. The robot relays its information to an external surgical control unit, where a cardiac surgeon has a three-dimensional view of the chest cavity, and twin controllers for the robotic arms. The procedure frequently involves grafting of the internal mammary artery to the diseased coronary artery, and therefore does not require external harvesting of blood vessels.

Patients will stay in the hospital for three to five days and make a full recovery in approximately 2 weeks compared to open CABG which is a seven-day hospital stay and six weeks of recovery.

RMIDCAB in Hybrid Revascularization

People with multi-vessel coronary disease, who desire a minimally invasive approach to surgery may be eligible for hybrid bypass. A hybrid approach combines coronary bypass (using the MIDCAB approach) and coronary stenting. 

This “hybrid” procedure is performed when a patient requires angioplasty for some blocked coronary arteries, but also has an LAD artery which has become so occluded that opening it with angioplasty is no longer possible. The procedure is typically done in two stages. The robotic bypass surgery, in which the patient’s mammary artery is grafted onto the LAD artery, is done first. This procedure has an extremely high success rate, with 97% of such grafts remaining open 10 years later. The patient then undergoes a non-invasive angioplasty procedure on the other blocked coronary arteries several days later. Since the coronary artery bypass segment is done through several small incisions between the ribs—avoiding the need to cut through the chest bone—and doesn’t require the patient to be placed on a heart-lung machine, the patient can usually be discharged from the hospital the same day that the angioplasty procedure is performed.

Hybrid procedures are rapidly gaining in popularity, both because of their highly favorable outcomes, and because they allow complete restoration of blood flow to the patient’s heart without the need for open-heart surgery, enabling a substantially faster recovery with minimal post-operative discomfort and scarring.

Patients will stay in the hospital for three to five days and make a full recovery in approximately 2 weeks compared to open CABG which is a seven-day hospital stay and six weeks of recovery.

Key Benefits

The advantages of minimally invasive cardiac surgery over traditional surgical methods often include:
  • Smaller incision and less visible scars
  • Less damage to muscle and tissue
  • Less pain and risk of infection
  • Lower blood loss as a result of surgery
  • Reduced hospital stay
  • Quicker recovery time

Traditional Heart Surgery

If minimally invasive cardiac surgery is not an option for your condition, your cardiac care team may recommend a more traditional surgical option as treatment. Traditional cardiac surgery, or open heart surgery as it is often referred, is performed by making a large incision, roughly 6-8”, in the chest to gain access to the heart. Once the heart is exposed, the heart is actually stopped and the patient is connected to a heart-lung bypass machine that does the work of the heart and lungs to allow the surgeon to perform the surgery.

Conditions Treated

Open heart surgery is often performed to treat:

  • Aortic Disease
  • Atrial Fibrillation
  • Coronary Artery Disease
  • Congenital Heart Disease
  • Heart Failure
  • Heart Transplants
  • Valvular Heart Disease
  • Place ventricular assistive devices (VADs) and  total artificial heart (TAHs)

Though similar heart conditions can be treated with minimally invasive methods, traditional surgery may be recommended for some patients based on factors such as age, previous heart treatments and overall health. Each patient will be evaluated to determine which surgical care option is best suited for their specific heart condition.

Types of Surgeries

Common traditional heart surgeries performed at Cedars-Sinai include:

Coronary artery bypass graft surgery (CABG), also called coronary artery bypass, coronary bypass or bypass surgery, is the most common type of heart surgery. More than 300,000 people have successful bypass surgery in the United States each year. 

In this procedure, a section of vein or artery from your leg, chest or another part of your body is used to bypass the blocked or diseased portion of a coronary artery, which brings blood to the muscle of your heart. This creates a new, clear way for the blood to flow to get oxygen to your heart muscle so it can work properly. This type of surgery is done to the outer walls of the heart; it doesn't require opening up the chambers of the heart.

Sometimes people talk about single, double, triple or quadruple bypass surgery. This refers to the number of blocked arteries that had to be bypassed. However, the need for more bypasses doesn't necessarily mean the heart condition is worse.

Typically during bypass surgery, the breastbone (sternum) is divided. The heart itself is stopped and cooled. The blood that normally would be pumped by the heart is sent through a heart-lung machine. Unlike other kinds of heart surgery, the chambers of the heart are not opened during bypass surgery.

A long piece of vein may be removed. Today, Cedars-Sinai heart surgeons use an artery from inside the chest wall (in 95% of cases because studies have shown that it improves long-term survival for the patient). In some cases, a small vessel from the lower arm, the radial artery, may be used for the bypass.

This is called a graft. One end will be attached to the ascending aorta, the large artery that carries oxygen-rich blood from the heart to the rest of the body. The other end of the graft will be attached to a coronary artery below the blocked area. The surgery takes two to six hours depending on the number of bypasses needed.

Off Pump Bypass Surgery

Cedars-Sinai heart surgeons also perform what is called off-pump or "beating-heart" bypass surgery. For most bypass surgeries, a heart-lung machine is used to do the work of the heart while the surgeon operates on it. In off-pump heart surgery, this machine is not used. New technologies now allow surgeons to stabilize a specific part of the heart, rather than the whole heart muscle. While the surgeon works on the controlled part of the heart, the rest of the organ continues to function. All arteries can be bypassed with this method. The off-pump technique is used for patients who have complications that put them at risk if using the traditional heart-lung machine method of bypass surgery.

Outcomes

Between 20 to 30% of bypass patients need a second bypass operation within 10 years. It is important that you take steps to prevent your heart disease from getting worse. This means limiting the amount of fat and cholesterol in your diet, maintaining a healthy weight, quitting smoking and learning new ways to cope with stress. Your doctor may recommend that you join to strengthen your heart and develop new behaviors.

When one or more of the four heart valves is damaged due to disease or defect, replacing or repairing through surgical treatment may be necessary.

Mitral Valve Surgery

Cedars-Sinai has a long history of performing mitral valve repair operations. Gaining expertise over the last 30 years has made our medical center the largest mitral valve repair center in the Los Angeles area. More than half of our mitral valve surgeries are the preferable mitral valve repairs.

The mitral valve opens and closes, controlling the blood flowing into the left side of the heart. Mitral valve repair may be needed because of aging, damage caused by a heart attack or other disease, or because of an abnormality present from birth.

Whenever possible, a heart valve should be repaired, not replaced. By repairing the valve rather than replacing it, a patient can avoid long-term use of blood thinners and problems, such as an infection.

A mitral valve can also be replaced using mechanical valves, tissue valves or homografts (valves donated by another person).

When the heart is severely damaged, other treatment options have failed or the heart is unable to be repaired, a heart transplant may be needed.  

Cedars Sinai performs the most heart transplants in the nation. Learn more about our comprehensive heart transplant care—from evaluation, during treatment and through recovery.

Key Benefits

Though benefits can vary depending on age, procedure performed and the individuals overall health, results of traditional heart surgery are very promising and include:

  • Reduced symptoms, such as chest pain and shortness of breath
  • Improves the supply of blood and oxygen to the heart
  • Can reduce the risk of heart attack
  • Less chance of vascular complications and stroke
  • Improved quality of life
Having Heart Surgery

Know what to expect before cardiac surgery, get ready for your hospital stay and explore resources for improving your recovery.

Get Help or Make an Appointment

Call us or send a message to the Cardiac Surgery Program. You can also have us call you back at your convenience.

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(1-800-233-2771)