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Alternative Names Return to topMinimally invasive direct coronary artery bypass; MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery
Definition Return to top
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart. It helps fix problems caused by coronary artery disease (CAD), in which the arteries that lead to your heart are partly or totally blocked.
Minimally invasive coronary (heart) artery bypass can be done without stopping the heart and putting a patient on a heart-lung machine.
Description Return to top
A heart surgeon will make a 3- to 5-inch-long incision (cut) in the left part of your chest between your ribs. This allows the surgeon to reach your heart. Muscles in the area will be pushed apart. A small part of the front of the rib, called the costal cartilage, will be removed. Then the surgeon will find and prepare an artery in your chest to attach to your coronary artery that is blocked.
Once the above steps are done, the surgeon will connect the prepared chest artery to your coronary artery that is blocked.
You will not need to be on a heart-lung machine for this surgery, but a device will be attached to your heart to slow it down.
Why the Procedure is Performed Return to top
Coronary arteries are the small blood vessels that supply your heart with oxygen and nutrients that are carried in your blood.
When one or more of the coronary arteries becomes partly or totally blocked, your heart does not get enough blood. This is called ischemic heart disease or coronary artery disease. It can cause chest pain (angina).
Coronary artery bypass surgery can be used to treat coronary artery disease. Your doctor may have tried to treat you with medicines only. You may have also tried cardiac rehabilitation.
Coronary artery disease varies a lot from person to person, so the way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment. It will be right for some people, but others may have other kinds of treatment.
Minimally invasive coronary artery bypass may be used when only 1 or 2 coronary arteries need a bypass and they are located around the front of the heart.
Risks Return to top
Ask your doctor about risks. In general, problems and complications with minimally invasive coronary artery bypass are lower than with open coronary artery bypass surgery.
Risks for any surgery are:
Possible risks with having coronary bypass are:
Before the Procedure Return to top
Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.
During the days before the surgery:
The day before your surgery:
On the day of the surgery:
Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure Return to top
You may be able to leave the hospital 2 or 3 days after your surgery. You may also be able to return to normal activities after 2 or 3 weeks.
Return to top
Recovery from surgery takes time, and you may not see the full benefits of your surgery for 3 to 6 months. In most people who have heart bypass surgery, the grafts remain open and working well for many years.
This surgery does NOT prevent the coronary artery blockage from coming back. You can do many things to slow it down. Not smoking, eating a heart-healthy diet, getting regular exercise, and treating high blood pressure, high blood sugar (if you have diabetes), and high cholesterol will all help.
You may be more likely to have problems with your blood vessels if you have kidney disease or some other medical problems.
References Return to top
Aziz O, Rao C, Panesar SS, Jones C, Morris S, Darzi A, et al. Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery. BMJ. 2007;334:617.
Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61.
Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4;116(23):2762-72. Epub 2007 Nov 12.Update Date: 12/13/2008 Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.