Minimally Invasive Surgery

New techniques in heart surgery have allowed many common open-heart operations to be performed through smaller and less traumatic incisions. Leveraging state-of-the-art surgical techniques to achieve the most optimal care for heart disease, we provide expertise in all aspects of minimally invasive surgical care for children, adolescents and adults. As a result, our patients experience a very low incidence of complications after cardiac surgery, resulting in less pain, shorter hospital stays, faster recovery and less anxiety for our patients. Our teams are in a unique position to provide optimal, individualized care for each patient.

What is Minimally Invasive Cardiac Surgery?

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 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.

When one or more of the four heart valves is damaged due to disease or defect, replacing or repairing the valves through surgical treatment may be necessary. Cedars-Sinai has a long history of performing minimally invasive heart valve surgery, which uses small incisions to repair or replace heart valves. 

Our surgeons are experts in robotic mitral valve surgery. This less invasive technique allows for greater precision of repairing or replacing the mitral valve and can lead to faster recovery for patients. Mitral valve repair may be needed due to aging, damage caused by a heart attack or other disease, or because of an abnormality present from birth. A mitral valve can also be replaced using mechanical valves, tissue valves or homografts (valves donated by another person).

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

Cedars-Sinai commonly performs other minimally invasive procedures including the MitraClip Procedure and Transcatheter Aortic Valve Replacement

Learn more about our 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 to minimally invasive cardiac surgery over conventional 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
Having Heart Surgery

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

Traditional Heart Surgery

If minimally invasive cardiac surgery is not an option for your condition, your cardiac care team may recommend traditional heart surgery as a treatment option.

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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