Keyhole surgery hope for heart patients

A new technique undergoing tests could cut hospital recovery time from 10 to 3 days.
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Keyhole surgery for the heart, which is undergoing clinical trials in three British hospitals, could replace conventional by-pass operations, doctors said yesterday.

The new technique allows the removal of a diseased blood vessel and the replacement of a new, healthy vessel, through several small incisions - the biggest is about seven centimetres long - in the patient's chest.

This compares with a nine- inch incision made in order to facilitate sternotomy - cutting through the breast bone - which is necessary for a coronary by-pass, during which veins from the legs are used to replace blocked arteries supplying the heart with oxygen.

American experience suggests this new approach to heart surgery will cut the length of stay in hospital from six to 10 days to about three days.

However, some heart specialists have cautioned against excessive optimism.

Although keyhole techniques for other surgical procedures have a valuable role to play in healthcare, there have been widespread problems which have diminished their early promise.

Unexpected complications have arisen during and after surgery which have necessitated prolonged hospital stays or readmission shortly after discharge. Some doctors, with minimal training in keyhole techniques, have been criticised for performing them.

Initially, the technique known as minimally invasive cardiac surgery (MICAS) will be used in patients with single-vessel heart disease and the trials will compare the results with similar patients being treated with angioplasty (in which a balloon is inflated inside the blocked vessel to remove the blockage) or by-pass.

A small number of patients have already been treated, have recovered well, and have been allowed home, a spokesman for the trial said yesterday.

Neil Moat, consultant cardiothoracic surgeon and leader of the trial at the Royal Brompton Hospital, London, said that if the trials were successful, the surgery would be extended to treat patients with multi-vessel disease.

Ciro Campanella, consultant cardiothoracic surgeon and leader of the trial at the Royal Infirmary, said: "This is an exciting opportunity to fully evaluate the benefits of minimally invasive cardiac surgery.

"This new approach has the potential to transform the way we will be working in the next few years. Furthermore, to be in association with Brompton and Papworth hospitals is a unique chance to share experience and assess more patients in a shorter time."