17438 Robotically Assisted Heart Surgery

Overview

Robotically assisted heart surgery is a way of doing heart surgery through a few very small cuts instead of a large one down the middle of the chest. The surgeon sits at a control console nearby and moves special robotic arms that hold tiny instruments and a camera. The arms copy the surgeon's hand movements very precisely, with less shaking and more range of movement. The camera gives a magnified, three-dimensional view inside the chest, so the surgeon can see the heart and surrounding tissue in fine detail. It is still real surgery, and the surgeon is in charge the whole time — the robot is a tool, not a decision-maker. It is used for certain heart operations, such as repairing or replacing heart valves, closing holes in the heart, and treating some abnormal heart rhythms.

It is not common. Open-heart surgery is still the most widely used approach, and robotic heart surgery is offered at specialised heart centres by teams who have been specially trained. How often it is used varies a lot between hospitals and countries.

It is considered for adults who need certain types of heart surgery and whose heart anatomy suits the technique — for example, some people with a leaking or narrowed heart valve, a hole in the heart, or an irregular heartbeat that needs a procedure. It is occasionally used in children with certain congenital heart problems, usually at specialist centres. People who have had previous chest surgery, have a lot of scarring, or have severe lung disease may not be suitable.

Symptoms

Common symptoms

• Robotic surgery is a treatment, not a condition, so the symptoms that matter are usually those of the heart problem that led to surgery.
• Feeling short of breath during everyday activity or when lying flat.
• Unusual tiredness or low energy.
• Chest discomfort or a feeling of pressure with exertion.
• A fluttering, racing or pounding heartbeat (palpitations).
• Swelling in the ankles, legs or feet.
• Dizziness or feeling faint.
• Some people have no symptoms at all and the problem is found during a routine check.

Symptoms in children

• Children with heart problems that may need surgery can show poor feeding, slow weight gain or slow growth.
• Breathlessness or sweating during feeds or play.
• Tiring quickly or being unable to keep up with other children.
• Bluish or greyish lips, tongue or fingernails in some heart conditions.
• Frequent chest infections.

Symptoms in older adults

• Breathlessness on stairs, hills or gentle exercise that was previously easy.
• A drop in stamina and needing to rest more often.
• Ankle or leg swelling, especially by the end of the day.
• A new heart murmur heard by a doctor.
• Palpitations or a noticeably irregular pulse.
• Feeling light-headed when standing up.

Causes

Main causes

• Robotic heart surgery is a treatment, so it does not have causes. It is used to treat heart conditions such as a heart valve that leaks or is narrowed.
• Holes between the chambers of the heart that were present from birth (congenital heart defects).
• Some types of coronary artery disease, where the heart's blood vessels are narrowed.
• Abnormal heart rhythms that need a procedure to correct them.
• Less often, growths or tumours inside the heart that need to be removed.

Risk factors

• Getting older — heart valve problems and coronary artery disease become more common with age.
• Smoking or long-term exposure to tobacco smoke.
• High blood pressure, high cholesterol or diabetes.
• Being overweight and not being physically active.
• A family history of heart disease.
• Previous chest surgery or radiation to the chest, which can make the robotic approach harder.
• Other health conditions that affect your suitability for surgery, such as severe lung disease or kidney disease.

When to see a doctor

See a doctor urgently if:

• Chest pain, pressure or tightness that is new or getting worse.
• Breathlessness that has become much worse over days or weeks.
• Fainting, near-fainting, or a very fast or irregular heartbeat.
• After surgery: fever, wound changes, worsening pain, or any symptom that worries you.

Book a routine appointment if:

• Feeling more tired or breathless than usual over weeks or months.
• Swelling in the ankles or legs that keeps coming back.
• A heartbeat you can feel fluttering or pounding.
• A heart murmur or unusual heart sound noticed during a check-up.
• Any questions about whether heart surgery, including a robotic approach, might be right for you.

Diagnosis

The decision to offer robotic heart surgery is made by a heart team rather than a single test. Your doctors will first confirm what is wrong with your heart, then work out whether the robotic approach is safe and suitable for your particular heart and body. They will also talk with you about the alternatives, including open-heart surgery and, where relevant, non-surgical treatments, and about the risks and benefits of each.

Tests that may be done

• Echocardiogram — an ultrasound scan of the heart that shows valves, chambers and blood flow.
• Transoesophageal echocardiogram — a closer scan done by passing a small probe down the throat, often used to plan valve surgery.
• CT scan of the chest — gives a detailed map of the heart and blood vessels and helps the team plan the small cuts.
• Coronary angiogram — a test using dye and X-rays to check the heart's arteries.
• Electrocardiogram (ECG) — records the heart's electrical rhythm.
• Chest X-ray and lung function tests.
• Blood tests, including checking your blood count, kidney function and blood clotting.
• A general health review, including dental checks, since healthy teeth and gums lower the risk of infection after surgery.

What to expect at your appointment

You will usually have an appointment with a heart surgeon and possibly a specialist nurse, where you can ask questions and talk through your options. You may be asked about your home situation, who can help you during recovery, and any medicines or supplements you take. Pre-operative checks can take several visits. If you feel unsure, it is fine to ask for more time, a second opinion, or another conversation with the team before deciding.

Treatment

Robotically assisted heart surgery is carried out under a general anaesthetic, so you will be asleep and feel nothing during the operation. The surgeon makes a few small cuts, usually on the side of the chest, and passes the camera and instruments through them. A heart-lung machine may be used to take over the work of the heart and lungs during the repair. Afterwards you will wake up in a recovery or intensive care area and be monitored closely, then moved to a normal ward. Most people go home within a few days, though this varies depending on the operation and how you recover.

Self-care at home

• Follow your team's instructions on wound care, and keep the small cuts clean and dry as advised.
• Take your pain relief as planned so you can move, breathe deeply and sleep comfortably.
• Do the breathing and gentle movement exercises your team gives you — they help prevent chest infections and blood clots.
• Build up walking gradually. Short, frequent walks are better than one long one at first.
• Avoid lifting heavy things, and ask your team when you can drive, return to work, or swim.
• Keep a simple note of your weight and how you feel, and bring it to follow-up appointments.
• Ask for help with shopping, cooking and chores for the first few weeks — accepting help speeds recovery.
• Stop smoking if you smoke, and ask for support to do so. This is one of the single biggest things you can do for your heart.

Medical treatments

Treatment after heart surgery usually combines several approaches, and your team will tailor a plan to you. Pain relief will be offered so you can move and breathe comfortably. Medicines to protect the heart and blood vessels may be reviewed or started, and if you have a mechanical valve or another reason for thinning the blood, your team will explain this in plain terms and arrange monitoring. You may also be given medicines to reduce the risk of infection or blood clots, and advice on protecting your stomach if needed. Cardiac rehabilitation — a supervised programme of exercise, education and support — is strongly encouraged and is one of the most effective ways to recover well. Ask your team which medicines you should continue, which to pause, and who to contact with questions; your pharmacist is a good source of practical advice.

When is surgery considered?

Surgery is considered when a heart problem is causing symptoms or putting strain on the heart and other treatments are not enough or not suitable. Robotic surgery may be offered when your heart's structure allows the surgeon to reach and repair the problem through small cuts, and when your general health makes a smaller operation a sensible choice. It is not right for everyone — for example, it is generally not used in an emergency, in people with a lot of scarring from previous chest surgery, or where the heart problem is best handled with a larger opening. In some situations, a surgeon may start robotically and then switch to open surgery because it is safer for you. This is a planned-for possibility, not a failure, and your team will discuss it with you beforehand.

Living with this condition

Most people feel noticeably better within a few weeks, but full recovery usually takes several weeks to a few months. In the first week or two you will likely tire easily and need more rest than usual. Small tasks may feel like hard work at first, and then get easier. Your small wounds will heal over a couple of weeks, and the soreness should steadily settle. Many people return to lighter daily activities within two to four weeks and to more normal routines within six to twelve weeks, though this depends on the operation, your age and your general health. Your team will give you a personalised timeline.

Lifestyle tips

• Build activity back gradually and aim for regular gentle exercise, such as walking, once you are cleared to do so.
• Eat a heart-friendly diet: plenty of vegetables, fruit, whole grains, beans, nuts, fish, and less salt and processed food.
• Keep alcohol within the limits your team advises.
• Stop smoking and avoid other people's smoke — ask for help, as it makes a real difference.
• Take medicines exactly as explained, and use a pill organiser or phone reminders if that helps.
• Keep an eye on your weight and tell your team about any sudden changes.
• Attend your follow-up appointments, even if you feel well.
• Go back to hobbies and social contact as soon as you feel able — they are part of recovery, not an extra.

Diet and exercise

Cardiac rehabilitation programmes combine supervised exercise, advice about food and help with stress and confidence. If one is offered, joining it is strongly recommended — people who complete rehab tend to recover better and feel more like themselves again. If you cannot attend a programme, ask for a home-based plan. Aim for a heart-friendly way of eating that you can keep up long term, rather than a strict short-term diet. Any big changes are easier with a little planning: a shopping list, a few simple recipes and help from family or friends can go a long way.

Mental health and emotional wellbeing

It is very common to feel anxious, flat or emotional before and after heart surgery. Some people have vivid memories or unsettling dreams, or find themselves worrying about their heart in a way they did not before. Others feel frustrated at how slow recovery seems. These feelings usually ease with time, rest and support. Talking to a partner, friend, GP or a specialist nurse helps. If low mood or anxiety persists, is affecting your sleep and appetite, or you have thoughts of harming yourself, please reach out to your doctor or local crisis support service straight away — you deserve help and you do not have to manage alone.

Prevention

You cannot prevent the need for heart surgery in every case — some heart valve problems and congenital heart conditions are not related to lifestyle at all. But looking after your heart and blood vessels lowers your risk of the conditions that most often lead to surgery. Not smoking, keeping blood pressure and cholesterol in a healthy range, staying active, eating well, limiting alcohol and managing diabetes all make a real difference. These steps also help you recover better if surgery is ever needed.

Vaccines

Ask your doctor or pharmacist about recommended vaccinations, such as yearly flu and other routine vaccines. People with heart conditions are often advised to have them, and getting them before planned surgery helps you go into the operation in the best possible health.

Screening programmes

Routine health checks can pick up high blood pressure, raised cholesterol or diabetes before they cause damage. Ask your GP or local health service how often you should be checked — this depends on your age, family history and other conditions. If a heart murmur or irregular heartbeat is ever noticed, it is worth following up even if you feel well.

Complications

If left untreated

• The underlying heart problem can slowly get worse, leading to increasing breathlessness, tiredness and limits on everyday life.
• The heart can become enlarged or weaker over time (heart failure).
• Some heart rhythm problems carry a higher risk of stroke.
• Untreated valve or artery disease can, in some people, lead to serious heart events.
• Living with symptoms can affect sleep, mood, work and relationships.

Long-term outlook

Most people recover well after robotically assisted heart surgery, and many notice less pain and get back to normal activities sooner than they would after open surgery. As with any heart operation, there are risks and a recovery period, and not every problem can be fixed with a small-incision approach. Your heart team will be honest with you about what is realistic in your case, and will tailor the plan to you. The great majority of people go on to live full, active lives after heart surgery, especially when they follow their recovery plan, keep up with cardiac rehabilitation and look after their heart health over the long term.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.