Minimally invasive heart surgery
Definition
Minimally invasive heart surgery refers to several approaches for bypassing critically blocked arteries. The minimally invasive procedures are less difficult and risky than conventional open heart surgery such as coronary artery bypass grafting, or CABG. The minimally invasive proceduresrestore 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 types of these procedures:
- Minimally Invasive Direct Coronary Bypass (MIDCAB)
- Off-Pump Coronary Artery Bypass (OPCAB)
- Robotic Assisted Coronary Artery Bypass (RACAB)
Patients who have one these procedures instead of open heart surgery have alower risk ofcomplicationsassociated with the heart-lung machine such as stroke, lung problems, kidney problems, and problems with mental clarity and memory. In addition to reduced complications, other benefits of minimally invasive heart surgery are faster recovery and reduced hospital costs.
Alternative Names
Minimally invasive direct coronary artery bypass; MIDCAB; Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery
Indications
MIDCAB: Due to the limited size of the MIDCAB incision, only certain patients are eligible for the procedure:
1. Patients who have a blockage in one or two coronary arteries located on the front side of the heart, but are considered too high-risk for conventional bypass surgery or balloon angioplasty.
2. Patients who are otherwise healthy but have a blockage in one or two coronary arteries located on the front side of the heart.
In general, every patient with coronary artery disease is a candidate for OPCAB. However, for younger patients, for those who have small coronary arteries and need several bypasses, or those whose heart will not tolerate being manipulated during the procedure, it may be preferable to use the traditional CABG technique. Currently, the following patients with coronary artery disease are potential candidates for OPCAB:
1. Patients with poor heart function (very low ejection fraction).
2. Patients with severe lung disease (chronic obstructive pulmonary disease, COPD, and emphysema).
3. Patients with acute or chronic kidney disease.
4. Patients at high risk for stroke.
5. Patients with a calcified aorta.
Convalescence
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. The average hospital stay is 3 days for MIDCAB patients and 5-7 days for OPCAB patients. In contrast, a hospital stay of 6-10 days is typical for conventional CABG patients.
Patients who have had MIDCAB have lower chest wound infection rates than patients who have undergone CABG or OPCAB. A smaller incision means less exposure and handling of tissue, which reduces the chance of infection.
MIDCAB patients recover more quickly than those who undergo CABG or OPCAB. Within 2 weeks, most MIDCAB patients can return to their normal activity level, compared with 2-3 months for patients who have had conventional surgery.
OPCAB patients have a recovery that in most respects is similar to that for CABG patients. Most are able to return to full activity, including work, 2-3 months after operation.
Risks
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. In addition, the stress on the heart during the procedure may lead to more heart muscle damage, lower blood pressure, irregular heart beat and potentially, brain injury if blood flow to the brain is reduced for too long during surgery. In some cases (usually less than 10%), it is necessary to convert to conventional CABG methods on an emergency basis.
Heart bypass surgery - series
Review Date: 4/2/2007
Reviewed By: A.D.A.M. Editorial Team: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy. Previously reviewed by J.A. Lee, M.D., Division of Surgery, UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network (5/30/2006).
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