What is a standard coronary artery bypass?
Standard coronary artery bypass grafting (CABG) is performed by accessing the heart through a 6- to 8-inch incision on the front of the chest and splitting the breast bone or sternum. The patient is then connected to the heart-lung machine which takes over the function of the patient’s heart and lungs. The heart is stopped to perform the coronary artery bypass graft operation. The heart is then restarted, and the patient is separated from the heart-lung machine.
Variations of coronary artery bypass
Off pump coronary artery bypass
Off-pump coronary artery bypass (OPCAB) is a technique that avoids the heart-lung machine and is performed without stopping the heart. In this technique, a small portion of the heart is stabilized adjacent to the vessel that we have identified for bypass. A heart surgeon places a device that looks like a tuning fork against that portion of the heart and immobilizes it while the rest of the heart beats normally.
Minimally invasive direct coronary artery bypass
Minimally invasive direct coronary artery bypass (MIDCAB ) is a technique that spares the breast bone. Instead, the heart surgeon makes a small incision under the left breast. Then the internal mammary artery that runs on the inside of the chest wall is harvested and attached to the coronary artery on a beating heart. Heart patients having this approach tend to leave the hospital sooner and recover faster but may experience more pain in the first few days.
ThoraCAB is a technique similar to the MIDCAB that approaches the heart from the side through a lateral or posterolateral thoracotomy. This approach gives the heart doctor access to blood vessels on the lateral and posterior aspects of the heart. It is particularly useful in patients who have isolated disease of the circumflex artery in a redo situation where standard approaches would jeopardize functioning bypass grafts to other parts of the heart, such as the anterior descending artery. The vein or artery used as a conduit for the bypass is attached at one end to the descending aorta.
Robotic MIDCAB is a technique that uses a robot to harvest the left internal mammary artery using a closed-chest approach prior to using a MIDCAB incision to complete the bypass. As with the traditional MIDCAB, it is possible to achieve bypass of multiple blockages. One advantage of the robot is that it allows the harvest of both mammary arteries and requires less distraction of the rib cage.
Transmyocardial Revascularization (TMR) is a technique that uses a laser to drill channels in the heart, allowing blood from the ventricular chamber to perfuse the heart directly. This approach is used when the patient's blood vessels are too small or too diseased to allow conventional bypass surgery and is often used in conjunction with bypass surgery when diffuse disease is present. Heart patients often experience relief of angina, but it is difficult to show increased blood flow.
Hybrid surgery is an approach whereby the heart surgeon and the interventional cardiologist work together to achieve complete revascularization of the heart. A MIDCAB approach is used to revascularize the anterior descending artery, and the remaining vessels are revascularized by stenting. This is especially useful in patients who are at high risk for standard surgical approach
Why choose Baylor Scott & White Health for heart surgery
Baylor Scott & White has been a major teaching and referral center for cardiovascular disease. It has a long tradition of excellence not only from its heart physician faculty but also from the ancillary and nursing staff. Cardiac surgery is a team endeavor with staff from several disciplines interacting to provide optimal care for the patient.
Physicians collaborate across disciplines and have established open lines of communication between the surgeons, cardiologists, anesthesiologists, intensivists, nurses, other ancillary staff and hospital administration such that they collectively form the surgical team.
Heart surgery patients are cared for from the preoperative visit through the hospitalization and the post-discharge follow up by a dedicated staff who report directly to the heart doctors and who are charged with keeping patients and their families completely informed of the heart patient’s progress.