Heart bypass surgery - minimally invasive?

Answer 1

Definition

Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to reach your heart. It helps fix problems caused by coronary artery disease (CAD), in which the arteries that lead to your heart are partly or totally blocked.

Minimally invasive coronary (heart) artery bypass can be done without stopping the heart and putting a patient on a heart-lung machine.

See also:

• Coronary bypass
• Angioplasty and stent placement

Alternative Names

Minimally invasive direct coronary artery bypass; MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery

Description

A heart surgeon will make a 3- to 5-inch-long incision (cut) in the left part of your chest between your ribs. This allows the surgeon to reach your heart. Muscles in the area will be pushed apart. A small part of the front of the rib, called the costal cartilage, will be removed. Then the surgeon will find and prepare an artery in your chest to attach to your coronary artery that is blocked.

Once the above steps are done, the surgeon will connect the prepared chest artery to your coronary artery that is blocked.

You will not need to be on a heart-lung machine for this surgery, but a device will be attached to your heart to slow it down.

Why the Procedure Is Performed

Coronary arteries are the small blood vessels that supply your heart with oxygen and nutrients that are carried in your blood.

When one or more of the coronary arteries becomes 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).

Coronary artery bypass surgery can be used to treat coronary artery disease. Your doctor may have tried to treat you with medicines only. You may have also tried cardiac rehabilitation.

Coronary artery disease varies a lot from person to person, so the way it is diagnosed and treated will also vary. Heart bypass surgery is just one treatment. It will be right for some people, but others may have other kinds of treatment.

Minimally invasive coronary artery bypass may be used when only 1 or 2 coronary arteries need a bypass and they are located around the front of the heart.

Risks

Ask your doctor about risks. In general, problems and complications with minimally invasive coronary artery bypass are lower than with open coronary artery bypass surgery.

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke
• Infection, including in the lungs, urinary tract, and chest
• Blood loss

Possible risks with having coronary bypass are:

• Some people report memory loss and loss of mental clarity or "fuzzy thinking." This is less common in people who have minimally invasive coronary artery bypass than in people who have open coronary bypass.
• Heart rhythm problems (arrhythmia)
• Sternal (chest) wound infection, which is more likely to happen in people who are obese, have diabetes, or have already had coronary bypass surgery
• Postpericardiotomy syndrome, a low-grade fever, and chest pain that can last up to 6 months

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before the surgery:

• For the 2-week period before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery. They include aspirin, ibuprofen (such as Advil and Motrin), naproxen (such as Aleve and Naprosyn), and other similar drugs. If you are taking clopidogrel (Plavix), talk with your surgeon about when to stop taking it.
• Ask your doctor which drugs you should still take on the day of the surgery.
• If you smoke, try to stop. Ask your doctor for help.
• Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness.
• Prepare your home for when you are discharged from the hospital.

The day before your surgery:

• Shower and shampoo well.
• You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap.
• You also may be asked to take an antibiotic to guard against infection.

On the day of the surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes Chewing Gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
• Take your drugs your doctor told you to take with a small sip of water.

Your doctor or nurse 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. You may also be able to return to normal activities after 2 or 3 weeks.

Outlook

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 working well for many years.

This surgery does NOT prevent the coronary artery blockage from coming back. You can do many things to slow it down. Not smoking, eating a heart-healthy diet, getting regular exercise, and treating high blood pressure, high blood sugar (if you have diabetes), and high cholesterol will all help.

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

References

Aziz O, Rao C, Panesar SS, Jones C, Morris S, Darzi A, et al. Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery. BMJ. 2007;334:617.

Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61.

Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116(23):2762-2772.

Answer 2

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 and putting a patient on a heart-lung machine.

See also:

• Coronary bypass
• Angioplasty and stent placement

Alternative Names

Minimally invasive direct coronary artery bypass; MIDCAB; Robot assisted coronary artery bypass; RACAB; Keyhole heart surgery

Description

A heart surgeon will make a 3- to 5-inch-long incision (cut) in the left part of your chest between your ribs. This allows the surgeon to reach your heart. Muscles in the area will be pushed apart. A small part of the front of the rib, called the costal cartilage, will be removed. Then the surgeon will find and prepare an artery in your chest to attach to your coronary artery that is blocked.

Once the above steps are done, the surgeon will connect the prepared chest artery to the coronary artery that is blocked.

You will not need to be on a heart-lung machine for this surgery, but a device will be attached to your heart to slow it down.

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, usually in the front of the heart. When one or more of the coronary arteries becomes 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).

Coronary artery disease (CAD) is when the small blood vessels that supply blood and oxygen to the heart become narrow or blocked.

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 a lot from person to person, so the way it is diagnosed and treated varies. Heart bypass surgery is just one treatment. It is not right for everyone.

Risks

Ask your doctor 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 for any surgery include:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke
• Infection of the lungs, urinary tract, and chest
• Blood loss

Possible risks of coronary artery bypass include:

• Memory loss, loss of mental clarity, or "fuzzy thinking" - less common in people who have minimally invasive coronary artery bypass than in people who have open coronary bypass
• Heart rhythm problems (arrhythmia)
• A chest wound infection - this is more likely to happen if you are obese, have Diabetes, or have had coronary bypass surgery in the past
• Low-grade fever and chest pain (together called postpericardiotomy syndrome), which can last up to 6 months

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before the surgery:

• For the 2-week period before surgery you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery. They include aspirin, ibuprofen (such as Advil and Motrin), naproxen (such as Aleve and Naprosyn), and other similar drugs. If you are taking clopidogrel (Plavix), ask your surgeon when you should stop taking it before surgery.
• Ask your doctor which drugs you should still take on the day of the surgery.
• If you smoke, try to stop. Ask your doctor for help.
• Contact your doctor if you have a cold, flu, fever, herpes breakout, or any other illness.
• Prepare your home so you can move around easily when you return from the hospital.

The day before your surgery:

• Shower and shampoo well.
• You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap.
• You also may be asked to take an antibiotic to guard against infection.

On the day of the surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.
• Take your drugs your doctor told you to take with a small sip of water.

Your doctor or nurse 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. You may also be able to return to normal activities after 2 or 3 weeks.

Outlook

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 do many things to slow it down. Not smoking, eating a heart-healthy diet, getting regular exercise, and treating high blood pressure, high blood sugar (if you have diabetes), and high cholesterol will all help.

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

References

Ferraris VA, Mentzer RM Jr. Acquired heart disease: coronary insufficiency. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 61.

Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116(23):2762-2772.

Moller CH, Perko MJ, Lund JT, et al. No major differences in 30-day outcomes in high-risk patients randomized to off-pump versus on-pump coronary bypass surgery: the best bypass surgery trial. Circulation. 2010 Feb 2;121(4):498-504. Epub 2010 Jan 18.

Thiele H, Neumann-Schniedewind P, Jacobs S, et al. Randomized comparison of minimally invasive direct coronary artery bypass surgery versus sirolimus-eluting stenting in isolated proximal left anterior descending coronary artery stenosis. J Am Coll Cardiol. 2009 Jun 23;53(25):2324-31.

Reviewed By

Review Date: 06/02/2010

Shabir Bhimji MD, PhD, Specializing in Cardiothoracic and Vascular Surgery, Midland , TX Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.