FEATURE
AN UPDATE ON LESS INVASIVE CARDIAC
SURGERY (LICS): An established option for
many patients requiring heart surgery.
Sebastian Pagni, MD
M
inimally Invasive Cardi-
ac Surgery (MICS) as is it
commonly defined, refers
to heart surgery procedures
performed through small
incisions (1). In my opinion, this term is in-
correct, confusing and often misrepresenting,
because it is not only the size of the incision
but a variety of other factors that decrease the impact of surgery. I
use a broader term, “less invasive cardiac surgery” (LICS) to define
a collection of cardiac surgery techniques and operation specific
instrumentation systems that allowed enhanced visualization and
work effectiveness. Thus, there is a decrease in the trauma of surgery
by not only the small incision, but also the preserving of the integ-
rity of the chest wall, lowering the level of pain and complications
and speeding up the recovering time and return to a normal life
style. Of equal importance to the incision size are the blood and
perfusion management strategies to avoid transfusion (2), strategies
to avoid infection and protocols used to promote early extubation
and mobilization.
To truly be a LICS procedure the overall impact of surgery should
be decreased but more importantly, the operation specific outcome
(i.e. valve repair, coronary bypass or completeness of an atrial abla-
tion) should be comparable to the standard open heart procedures.
In 2012, I wrote an article in this same magazine titled “Less Inva-
sive Cardiac Surgery: Is it here to stay?” (3). I was concerned about
the over criticism and “demonization” of these procedures by other
physicians. I wrote those lines with optimism, believing in its benefit
to patients and in a future of more adoption and interest. I empha-
sized on the difficulty and pains of overcoming the learning curve,
the risking of referrals and the dual impact on patient outcomes
and doctor prestige. I elaborated on the importance of the surgeon
truly believing in the approach to be the key to success. I didn’t think
then and I still don’t think now, that many patients, surgeons and
referrals alike have a clear understanding of the benefits we look for
when we offer these procedures. I failed to describe my thoughts on
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LOUISVILLE MEDICINE
the importance of the less invasive cardiac surgery (lower impact of
any cardiac operation) concept vs. the minimally invasive cardiac
surgery concept (small incision required to qualify for it). Is it all
Typical mitral valve repair with a ring and posterior (P2) leaflet
resection (A) with a LICS mini thoracotomy approach (B).