Minimally invasive heart surgery
Key points
- Minimally invasive heart surgery refers to several approaches for bypassing critically blocked arteries that are less difficult and risky than conventional open-heart surgery (coronary artery bypass grafting - CABG).
- MIDCAB: This procedure offers the benefits of conventional CABG but produces less traumatic injury; the recovery may be closer to that experienced by angioplasty patients.
- Performing surgery on a beating heart (for both MIDCAB and OPCAB procedures) is technically more difficult than working on a heart that has been stopped with the help of the heart-lung machine.
- MIDCAB and OPCAB patients typically spend one day in the surgical intensive care unit and then move to a regular surgery unit, where they receive cardiac rehabilitation.
Alternative names
Minimally invasive direct coronary artery bypass (MIDCAB); Off-pump coronary artery bypass (OPCAB); Beating heart surgery; RACAB (robot assisted coronary artery bypass); Keyhole heart surgery
Definition
Minimally invasive heart surgery refers to several approaches for bypassing critically blocked arteries that are less difficult and risky than conventional open-heart surgery (coronary artery bypass grafting - CABG). These approaches restore healthy blood flow to the heart without having to stop the heart and put the patient on a heart-lung machine during surgery.
Currently, there are three procedures that use this approach: Minimally Invasive Direct Coronary Bypass (MIDCAB), Off-Pump Coronary Artery Bypass (OPCAB), and Robotic Assisted Coronary Artery Bypass (RACAB). Each of these procedures has the potential benefit of avoiding complications associated with the heart-lung machine such as increased risk of stroke, lung complications, kidney complications, and problems with mental clarity and memory. Other benefits are faster recovery and reduced hospital costs.
MIDCAB is suitable for patients with blockage(s) in the arteries on the front of the heart - that is, the left anterior descending (LAD) artery and its diagonal branches. This procedure allows the surgeon to perform bypass surgery without splitting the breastbone. Unlike conventional open-heart bypass surgery, which requires a large incision, MIDCAB employs a tiny, 6-10 cm "keyhole" incision on the patient's left chest to gain access to the heart. Surgeons may use MIDCAB incisions with or without the heart-lung machine.
With OPCAB, the surgeon makes a vertical incision in the chest the same as that used in conventional bypass surgery, and splits the breastbone. The difference is that the heart-lung machine is not used. A stabilizing device is used to restrict movement of small segments of the heart so that the surgeon can operate on it while it is still beating. This procedure enables the surgeon to perform multiple-vessel (4-5) bypass surgery on a beating heart.
RACAB is the latest advance in coronary surgery. Surgeons use a robotic device to enable coronary bypass without separating the breastbone at all. Surgeons do not have direct contact with the patient, but perform the operation while watching a videoscreen. As the technology becomes more advanced, the surgeon may perform coronary bypass from a distant site (that is, from another room or another geographical location).
Description
MIDCAB: This procedure offers the benefits of conventional CABG but produces less traumatic injury; the recovery may be closer to that experienced by angioplasty patients. Unfortunately, this procedure is limited to a small subset of patients requiring bypass surgery who need only 1-2 bypasses.
Written and revised by
Andrey Nailor, M.D.
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