Coronary Artery Bypass

Coronary Artery Bypass or CABG has grown to be one of most common surgical procedures performed in the U.S.

Since its' inception in the early 60’s these operations have been most commonly performed with the use of the "Heart-Lung" machine, also developed in the 1960's, enabling surgeons to work on the heart which could be "arrested" or stopped, enabling it to be opened to access the valves, and facilitating the delicate suturing of the bypass grafts to the coronary arteries which are on the surface of the heart.

Cardiopulmonary bypass however has been associated with its' own problems and complications. Having the blood circulate outside the body, through plastic tubing and through an oxygenator results in damage to cells, bleeding problems and both subtle and sometimes not so subtle neurologic changes! These are exceedingly rare, but can be devastating.

About 15 years ago cardiac surgeons began to attempt sewing the grafts onto the vessels of the heart while it was still beating and without the assistance of the bypass machine! Initially crude, the "stabilizing" instruments kept a small segment of the heart still while the surgeon sutured the vein or artery onto the coronary artery of the heart. Over the last decade these “stabilizers” have been improved and we at Twin Cities Heart and Lung , like others persisted and have become exceedingly comfortable doing these operations on almost all of our patients. In 2010 more than 95% of our bypass patients were operated upon, without stopping the heart. In the U.S. however, only 20% of the bypass operations are done in this manner.

When compared to traditional coronary artery bypass procedures where the patients’ heart is stopped, and the heart-lung machine used, beating heart bypass procedures have been shown to reduce:

• Transfusion rates by 48%
• Length of post-operative hospital stay by 40%
• Hospital costs by 24%

In our patients operated on using this “beating” heart technique we have found that our operative times are significantly less. Our average operation lasts between 60 and 90 minutes less than the national average . This means less anesthesia, less time on the ventilator and this results in a significantly less hospital stay and quicker recovery. In a well recognized national database of CABG outcomes, our patients are consistently in the top 5% in hospital stay, ventilatory times and reduced ICU stay.

Minimally Invasive Technique

Minimally invasive coronary artery bypass (MIDCAB) surgery is an option for some patients who require a left internal mammary artery (LIMA) bypass graft to the left anterior descending (LAD) artery.

The benefits of minimally invasive surgery include a smaller incision (3 to 4 inches instead of the 6- to 8-inch incision with traditional surgery) and smaller scars. Da Vinci Robot is used to harvest the LIMA and a small incision on the left chest is used to connect the vessel to the LAD.

Traditional incision	Minimally invasive incision

In our experience, the so-called “Mid CAB” approach is offered for those patient who need only one or maybe two bypasses and who are anxious to return to full physical activity soon after surgery, ie. manual labor or active sports. We will also often offer this to appropriate patients for whom a traditional sternal incision might be very risky for a serious wound infection, ie. obese diabetics, immunocompromised patients, etc.

The surgical team will carefully compare the advantages and disadvantages of minimally invasive CABG surgery versus traditional CABG surgery. Your surgeon will review the results of your diagnostic tests before your surgery to determine if you are a candidate for any of these minimally invasive procedures.