Coronary artery bypass grafting (CABG) is a surgical treatment for blocked coronary arteries. Coronary arteries supply blood to the heart muscle and when blockages in these arteries form, chest pain, shortness of breath and heart attacks can occur. Catheter procedures performed by interventional cardiologists address the blockages themselves with stents. Coronary bypass surgery performed by cardiac surgeons reroutes the blood around the blockages to supply better blood supply to the heart muscle and is a better treatment option, although more invasive, for certain patients and more durable for most patients.
Bypass surgery is traditionally done through an open conventional approach. This technique divides the sternum to access the heart. The grafts to reroute blood are constructed using one or both arteries from under the sternum, veins from the legs and sometimes an artery from the forearm. These conduits are connected to the aorta just above the heart, then connected to the coronary artery beyond the blockage. These connections are made with the heart lung machine. Depending on the coronary anatomy and patient characteristics, arteries and/or veins are used.
There have been a number of advances in coronary bypass surgery including more minimally invasive surgery. These alternative methods may use smaller than the traditional incisions, may not use the heart lung machine, and may use the robot to assist in achieving the same goals of coronary grafting.
Offpump coronary artery bypass (OPCAB) is a technique of bypassing coronary arteries without the heart lung machine and with the heart beating. Using heart stabilizers, anastomotic devices and coronary shunts, grafts are connected to the native arteries. This method is a suitable and safe technique for certain patients.
Minimally invasive direct coronary artery bypass (MIDCAB) is a good technique for isolated left anterior descending artery disease (LAD). The artery under the sternum (the mammary artery) is harvested off the chest wall and using a small incision in the side of the chest, the mammary artery can be sewn onto the artery. This avoids splitting the sternum but limited to most commonly single vessel coronary artery disease.
The Robot is a computer enhanced device that gives maximal magnification and therefore visualization with robot instruments that allow for much flexibility through small incisions. The surgeon sits at a console and looks through the eyepiece to manipulate the robot arms with attached instruments. In this way, the robot can take down the mammary artery through very small incisions. In very select patients, the robot can make help make the connection between the graft and the coronary artery which is called totally endoscopic coronary artery bypass (TECAB).
Hybrid revascularization is another emerging alternative to coronary grafting. For patients with multi vessel coronary artery disease, both percutaneous coronary intervention (PCI) and minimally invasive CABG can be performed during the same procedure if a hybrid OR is used, or staged during the same hospitalization. The Robot can be added to the MIDCAB portion of this procedure to assist in taking down the mammary artery.
There are certainly risks with any technique of coronary artery bypass surgery. The key is knowing which procedure is best and safe for each patient.Your surgeon can go over your specific risks and recommend conventional or innovative procedures.