A Patient's Guide to Heart Surgery
Minimally Invasive Heart Bypass Surgery
Recent advances in surgical technique and equipment allow the surgeon to perform coronary artery bypass surgery in a less traumatic way. These types of procedures are called "minimally invasive". Minimally invasive cardiac surgery (MICS) may include a smaller incision, avoidance of the heart-lung machine, or both.
For select patients, the surgeon may decide that minimally invasive bypass surgery is appropriate. MICS (minimally invasive cardiac surgery) procedures are often done on a beating heart or through a smaller incision. Pioneering work is also being done throughout the world to develop techniques that will allow surgeons to perform beating-heart bypass procedures through "keyhole" incisions.
Unlike conventional surgery, which has a 10"-12" incision and places the patient on the heart-lung machine, new minimally invasive approaches may avoid placing the patient on a heart-lung machine, and can be performed through a 3"-5" incision placed between the ribs, or may be done with several small incisions. "Keyhole" or "endoscopic" bypass procedures, which are still in development, are performed through small incisions measuring 1"-2" wide.
Coronary Artery Bypass Grafting (CABG)
Coronary Artery Bypass Grafting (CABG), or bypass surgery, is a safe and effective way of surgically treating the symptoms of coronary artery disease. It is a procedure that reroutes the blood around a blockage in the coronary artery, creating an alternative pathway for blood to deliver important nutrients and oxygen to the heart muscle.
Grafts are created by using portions of another artery or vein from the patient's body. The most commonly used vessels are the internal mammary arteries, which are inside the chest wall, or the greater saphenous veins, which are in the leg. These vessels are "spares." Blood flow is usually not affected by removing them. Less often, the radial artery in the arm may be used for a graft. Grafts usually last for 10 to 12 years.
Potential Patient Benefits of Minimally Invasive Heart Bypass Surgery
Minimally invasive bypass surgery is believed to have the same beneficial results as conventional bypass surgery--restoring adequate blood flow and normal delivery of oxygen and nutrients to the heart. Minimally invasive bypass surgery, however, has additional advantages related to the ability of the surgeon to work on a beating heart or through smaller incisions.
Shorter length of stay: Patients may experience less pain and may have a better ability to cough and breathe deeply after the operation so they are often discharged from the hospital in 2 to 3 days, compared to the typical 5 to 10 days for conventional CABG surgery.
Faster recovery: Avoidance of the heart-lung machine and the use of smaller incisions may reduce the risks of complications such as stroke and renal failure so that patients can return to their normal activities in 2 weeks rather than the typical 6 to 8 weeks with conventional surgery.
Less bleeding and blood trauma: Any time blood is removed from the body and put into the heart-lung machine, the patient must be put on anticlotting medications or given "blood products". Artificial circuits such as the heart-lung machine can also damage blood cells. These factors may affect the blood's ability to clot after surgery. Avoiding the heart-lung machine can alleviate this blood trauma.
Lower infection rate: A smaller incision means less exposure and handling of tissue, which may reduce the chances of infection.
Available to more patients: Some patients are poor candidates for traditional bypass surgery because their illness is too widespread, their heart is too weak, or because they will not accept blood products. Some patients are able to receive this life-saving surgery through minimally invasive techniques.
Less cost: The cost of minimally invasive cardiac surgery may be approximately 25% less than the cost of conventional surgery.
How do surgeons perform surgery on a beating heart?
One of the greatest challenges in minimally invasive bypass surgery is the difficulty of suturing or "sewing" on a beating heart. If the surgeon chooses to operate on a beating heart, a stabilization system is used to steady only the portion of the heart where the surgeon is operating. A stabilization system avoids use of the heart-lung machine by making it possible for the surgeon to carefully work on the patient's heart while it continues to beat.
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