Medical Health Encyclopedia

Minimally invasive heart surgery

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 (that is, from another room or another geographical location).

Alternative Names:
Minimally invasive direct coronary artery bypass (MIDCAB); Off-pump coronary artery bypass (OPCAB); Beating heart surgery; RACAB (robot assisted coronary artery bypass); Keyhole heart surgery

Description:

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MIDCAB: This procedure offers the benefits of conventional CABG but produces less traumatic injury; the recovery may be closer to that experienced by angioplasty patients. Unfortunately, this procedure is limited to a small subset of patients requiring bypass surgery who need only 1-2 bypasses.

During the operation, the surgeon makes an incision approximately 6-10 cm long on the front of the chest toward the left side. The pectoral muscles are divided and a small portion of the front of the rib, the costal cartilage, is removed. The surgeon clamps off the internal mammary artery (IMA), which lies just beneath this cartilage, and frees its lower end. An opening is made in the pericardium, the sheath covering the heart.

A mechanical stabilizer is attached to the heart to reduce its movement, and the surgeon connects the mammary artery below the blockage to the left anterior descending (LAD) artery and/or one of its branches. Once the clamp on the mammary artery is released, blood can flow from the IMA through the LAD artery, bypassing the blockage and providing oxygen-rich blood to the heart muscle.

OPCAB: The use of this procedure has grown significantly because of its advantages over conventional CABG and the MIDCAB procedure. Compared with patients undergoing conventional CABG, those undergoing OPCAB require fewer blood transfusions, may have a decreased risk of stroke, have a shorter post-operative hospital stay, and may be able to return to normal activities more rapidly.