coronary artery bypass graft (CABG) surgery is very
successful in improving blood flow to the heart. But the procedure is very
invasive to your body for two major reasons:
Because of this level of invasiveness, the procedure can cause
several complications. Surgeons have developed several new methods that
minimize the invasiveness and risks involved with CABG surgery. But minimally invasive CABG surgery is not available everywhere. And minimally invasive CABG surgery is not right for everyone.
Beating-heart surgery is different from the standard CABG surgery. During a standard CABG procedure, your heart will be stopped and you
will be connected to a heart-lung bypass machine. Beating-heart surgery (BHS)
is unique because the procedure is performed while your heart is still beating, without the heart-lung bypass
There are two main types of beating-heart surgery (BHS), which is
also called minimally invasive CABG surgery:
Minimally invasive direct coronary artery bypass (MIDCAB) surgery
differs from traditional CABG surgery in two ways. First, the MIDCAB procedure
does not use the heart-lung bypass machine. Second, your surgeon will cut
several small incisions (thoracotomies) in your chest to access your coronary
arteries instead of the one large incision (sternotomy) used in traditional
CABG surgery. These smaller incisions expose only the sections of your arteries
that require grafts, instead of your entire heart. As a result, you have a lower risk of infection. You also do not have the large scar associated with traditional CABG surgery.
The main disadvantage of MIDCAB is that it cannot be used to treat
several diseased vessels, especially if arteries on both the left and right
sides of the heart are blocked. The limited number of small incisions made
using MIDCAB makes it difficult to treat more than two coronary arteries during
the same surgery.
The off-pump coronary artery bypass (OPCAB) technique is another type
of beating-heart surgery that requires the same large incision as traditional
CABG surgery. OPCAB eliminates the use of a heart-lung bypass machine and may
not require manipulation of the aorta.
The OPCAB procedure is performed basically the same way as
traditional CABG surgery, except that the heart-lung bypass machine is not used
and the aorta is not clamped.
You and your doctor can discuss whether minimally invasive CABG
surgery is appropriate for you. The decision depends on your overall health,
how bad your coronary artery disease is, how many bypasses need to be
created, and various other factors. If you choose to have the surgery, it is
important to ask how experienced your cardiac surgeon is in doing these types
There are advantages and disadvantages to the various types of
minimally invasive CABG surgeries. With information and communication, you and
your doctor can make an appropriate decision about which CABG procedure is best
Other Works Consulted
Hillis LD, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 124(23): e652–e735.
Sabik JF, et al. (2011). Coronary bypass surgery. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 2, pp. 1490–1503. New York: McGraw-Hill.
April 15, 2013
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
& Robert A. Kloner, MD, PhD - Cardiology
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