Center for Less Invasive Cardiac Surgery (CLICS)
Baptist Health Louisville is the leading Center in the region offering minimally invasive “small incision” cardiac surgery procedures. Our surgeons have pioneered these techniques in the area over the last 20 years and they have modified or developed own techniques.
These advanced techniques spare the use of full splitting of the breastbone by using alternative small incisions (Fig. 1) (4-6 cm) between the ribs in the lateral chest wall (lateral mini-thoracotomy), a small window in the upper right chest (anterior mini-thoracotomy) or a window in the upper mid chest (mini-sternotomy) where a small split of the upper sternum is performed, in all these forms, maintaining the integrity of the chest cage with decreased chest trauma from the incisions compared to the traditional open heart surgery approach.
Using especially designed instruments (long shaft), optic systems and supportive perfusion techniques, most of the isolated mitral and tricuspid valve repairs and replacements, aortic valve replacements and selected aortic aneurysms and coronary bypasses are performed routinely in our centers.
Fig. 1 – Description of different surgical approaches
Although doing surgery through “small incisions” is important to decrease the invasiveness of surgery, in our opinion, it is only one aspect of the whole picture in the aim of minimizing the impact of surgery. Our unique concept of “Less Invasive cardiac surgery” incorporates other aspects involved in the performance of the procedure and in the aftercare of the patient that are equally important to small incisions, such as: (1) improved cardiopulmonary bypass techniques resulting in lower levels of blood cell damage, (2) neurologic protection and monitoring methods, (3) own protocols to minimize blood transfusion during surgery and hospital stay, (4) strict sterile technique to avoid infections, (5) use of repair techniques over replacement whenever feasible, (6) early extubation after surgery, (7) pain control management postoperatively and (8) early mobilization and pulmonary therapy after surgery, amongst others.
Our unique LICS approach is used universally in all patients, small and standard incisions alike, resulting in:
- Shorter length of stay
- Early return to a normal life style (2-4 weeks)
- Low transfusion rates (1/3 of the Society of Thoracic Surgeons national average)
- Low complication rates
- Lower postoperative pain levels
- Satisfactory cosmetic result
- Lower infection rate
Our approach offers a better (positive) surgical experience for the patients and families in the hospital as well as the convalescence period at home.
Our Center for Less Invasive Cardiac Surgery offers a comprehensive approach to all patients consulting for a potential cardiac operation. Individual cases are discussed in a Valve Conference by surgeons and cardiologists to evaluate the different approaches to be tailored to the patient. Our team of surgical assistants, physician assistants (PA) and nurse practitioners (ARNP)are involved from the consultation to the late postoperative care and facilitate the surgical process with patients and families alike.
Typical cases referred to our center for: ”less invasive” or “mini” procedures are:
- Mitral valve repair and replacement
- Aortic valve repair and replacement
- Tricuspid valve repair and replacement
- Atrial septal defect closure
- Septal myectomy operations (HOCM)
- Cardiac masses removal/tumors
- Coronary artery bypass (MICSCABG)
- Ascending aortic aneurysms
- TAVR (percutaneous aortic valve implants)