Heart bypass surgery - minimally invasive

Definition

Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart.

Minimally invasive coronary (heart) artery bypass can be done without stopping the heart. Therefore, you do not need to be put on a heart-lung machine for this procedure.

Alternative Names

Minimally invasive direct coronary artery bypass; MIDCAB; Robot-assisted coronary artery bypass; RACAB; Keyhole heart surgery; CAD - MIDCAB; Coronary artery disease - MIDCAB

Description

To perform this surgery:

You will not be on a heart-lung machine for this surgery. However, you will have general anesthesia so you will be asleep and not feel pain. A device will be attached to your heart to stabilize it. You will also receive medicine to slow the heart down.

You may have a tube in your chest for drainage of fluid. This will be removed in a day or two.

Why the Procedure Is Performed

Your doctor may recommend a minimally invasive coronary artery bypass if you have a blockage in one or two coronary arteries, most often in the front of the heart.

When one or more of the coronary arteries become 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).

Your doctor may have first tried to treat you with medicines. You may have also tried cardiac rehabilitation or other treatments, such as angioplasty with stenting.

Coronary artery disease varies from person to person. Heart bypass surgery is just one type of treatment. It is not right for everyone.

Surgeries or procedures that may be done instead of minimally invasive heart bypass are:

Risks

Your doctor will talk to you about the risks of surgery. In general, the complications of minimally invasive coronary artery bypass are lower than with open coronary artery bypass surgery.

Risks related to any surgery include:

Possible risks of coronary artery bypass include:

Before the Procedure

Always tell your doctor 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 will tell you when to arrive at the hospital.

After the Procedure

You may be able to leave the hospital 2 or 3 days after your surgery. The doctor or nurse will tell you how to care for yourself at home. You may be able to return to normal activities after 2 or 3 weeks.

Outlook (Prognosis)

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 work well for many years.

This surgery does not prevent a blockage from coming back. However, you can take steps to slow it down. Things you can do include:

You may be more likely to have problems with your blood vessels if you have kidney disease or other medical problems.

References

Baron SJ, Mick S, Shekar PS, Mauri L. Advances in coronary revascularization. In: Antman EM, Sabatine MS, eds. Cardiovascular Therapeutics: A Companion to Braunwald's Heart Disease. 4th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 11.

Hillis LD, Smith PK, Anderson JL, 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. 2011;124(23):e652-e735. PMID: 22064599. www.ncbi.nlm.nih.gov/pubmed/22064599.

Mick S, Keshavamurthy S, Mihalejevic T, Bonatti J. Robotic and alternative approaches to coronary artery bypass grafting. In: Sellke FW, del Nido PJ, Swanson SJ, eds. Sabiston and Spencer Surgery of the Chest. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 90.

Omer S, Cornwell LD, Bakaeen FG. Acquired heart disease: cornoary insufficiency. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 59.


Review Date: 5/24/2016
Reviewed By: Mary C. Mancini, MD, PhD, Department of Surgery, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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