Alternate Names : Beating Heart Surgery, Keyhole Heart Surgery, Minimally Invasive Direct Coronary Artery Bypass (MIDCAB), Off-Pump Coronary Artery Bypass (OPCAB), RACAB (Robot Assisted Coronary Artery Bypass)

Definition

Minimally invasive heart surgery refers to several approaches for bypassing critically blocked arteries that are less difficult and risky than conventional open-heart surgery (coronary artery bypass grafting -- CABG). These approaches restore 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 procedures that utilize this approach: Minimally Invasive Direct Coronary Bypass (MIDCAB), Off-Pump Coronary Artery Bypass (OPCAB), and Robotic Assisted Coronary Artery Bypass (RACAB). Each of these procedures have the potential benefit of avoiding complications associated with the heart-lung machine such as increased risk of stroke, lung complications, kidney complications and problems with mental clarity and memory. Other benefits are faster recovery and reduced hospital costs.

MIDCAB is suitable for patients with blockage(s) in the arteries on the front of the heart -- i.e., the left anterior descending (LAD) artery and its diagonal branches. This procedure allows the surgeon to perform bypass surgery without splitting the entire breastbone. Unlike conventional open-heart bypass surgery, which requires a large incision, MIDCAB employs a tiny, 6-10 cm "keyhole" incision on the patient's left chest to gain access to the heart. Surgeons may use MIDCAB incisions with or without the heart-lung machine.

With OPCAB the surgeon makes a vertical incision in the chest; the size of an incision used in conventional bypass surgery, and splits the breastbone. The difference is that the heart-lung machine is not used. A stabilizing device is used to restrict movement of small segments of the heart so that the surgeon can operate on it while it is still beating. This procedure enables the surgeon to perform multiple (4-5) vessel bypass surgery on a beating heart.

RACAB is the latest advance in coronary surgery. Surgeons use a robotic device to enable coronary bypass without separating the breastbone at all. Surgeons do not have direct contact with the patient, but perform the operation while watching a videoscreen. As the technology becomes more advanced, the surgeon may perform coronary bypass from a distant site (i.e., from another room or another geographical location).