Minimally invasive coronary artery bypass surgery

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This article was last updated on 5/29/2008.
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Standard coronary artery bypass graft (CABG) surgery is very successful in improving blood flow to the heart. However, the procedure is very invasive to your body for two major reasons:

  • It involves making a large chest incision to expose your heart and arteries.
  • It requires stopping your heart and connecting you to a heart-lung bypass machine that takes over the work of your heart and lungs.

Because of this level of invasiveness, the procedure can cause several complications. Surgeons have developed several new methods that minimize the invasiveness and risks involved with CABG surgery. But minimally invasive CABG surgery is not available everywhere. And minimally invasive CABG surgery is not right for everyone.

Beating-heart surgery

Beating-heart surgery is different from the standard CABG surgery. During a standard CABG procedure, your heart will be stopped and you will be connected to a heart-lung bypass machine. Beating-heart surgery (BHS) is unique because the procedure is performed without the heart-lung bypass machine while your heart is still beating.

There are two main types of beating-heart surgery (BHS), which is also called minimally invasive CABG surgery:

  • Minimally invasive direct coronary artery bypass (MIDCAB)
  • Off-pump coronary artery bypass (OPCAB)

MIDCAB

Minimally invasive direct coronary artery bypass (MIDCAB) surgery differs from traditional CABG surgery in two ways. First, the MIDCAB procedure does not use the heart-lung bypass machine. Second, your surgeon will cut several small incisions (thoracotomies) in your chest to access your coronary arteries instead of the one large incision (sternotomy) used in traditional CABG surgery. These smaller incisions expose only the sections of your arteries that require grafts, instead of your entire heart. As a result, you have a lower risk of infection. You also do not have the large scar associated with traditional CABG surgery.

The main disadvantage of MIDCAB is that it cannot be used to treat several diseased vessels, especially if arteries on both the left and right sides of the heart are blocked. The limited number of small incisions made using MIDCAB makes it difficult to treat more than two coronary arteries during the same surgery.

OPCAB

The off-pump coronary artery bypass (OPCAB) technique is another type of beating-heart surgery that requires the same large incision as traditional CABG surgery. OPCAB eliminates the use of a heart-lung bypass machine and may not require manipulation of the aorta.

The OPCAB procedure is performed basically the same way as traditional CABG surgery, except that the heart-lung bypass machine is not used and the aorta is not clamped.

Is minimally invasive CABG surgery right for you?

You and your doctor can discuss whether minimally invasive CABG surgery is appropriate for you. The decision depends on your overall health, the severity of your coronary artery disease, how many bypasses need to be created, and various other factors. If you choose to have the surgery, it is important to ask how experienced your cardiac surgeon is in doing these types of surgery.

The chart below lists examples of people who may want to consider minimally invasive CABG surgery.

Candidates for minimally invasive procedures

If you:

You may want to consider:

Such as:

Have a low red blood cell countA procedure that does not require use of the heart-lung bypass machineMIDCAB or OPCAB
Have had radiation treatment in the pastA procedure that involves smaller incisionsMIDCAB

The chart below lists some advantages and disadvantages of minimally invasive CABG surgery compared with traditional CABG surgery.

Advantages and disadvantages of minimally invasive CABG

Advantages

Disadvantages

Decreased recovery time

May need to operate again

Decreased inflammation of body tissue

Limited use (can only access a few coronary arteries, best for accessing arteries that supply the left side of the heart)

Beating-heart surgeries (BHS) only: Decreased risk of complications associated with heart-lung bypass machine (such as irregular heart rhythm)Limited evidence that minimally invasive CABG surgery is as good as or better than traditional CABG surgery

Final thoughts

There are advantages and disadvantages to the various types of minimally invasive CABG surgeries. With information and communication, you and your doctor can make an appropriate decision about which CABG procedure is best for you.

Author: Robin Parks, MSLast Updated: May 29, 2008
Medical Review: Caroline S. Rhoads, MD - Internal Medicine
Robert A. Kloner, MD, PhD - Cardiology
Ruth Schneider, MPH, RD - Diet and Nutrition

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