Minimally Invasive Coronary Artery Bypass Surgery

Minimal Invasive Cardiac Surgery (CABG) in India: Transforming Heart Surgeries with Precision and Safety

MICS Bypass Surgery stands for “Minimally Invasive Coronary Artery Bypass Surgery.” It is a specialized surgical technique used to treat blocked or narrowed coronary arteries in a less invasive manner compared to traditional open-heart coronary artery bypass graft (CABG) surgery

Like all body organs, the heart also needs a constant blood supply. The blood is supplied via two large blood vessels, the left and right coronary arteries. However, these arteries become narrow and hardened over time by depositing fatty acids known as plaques. This is known as atherosclerosis.

People suffering from this disease are said to have coronary heart disease. The best treatment option in India to treat coronary heart disease is Coronary Artery Bypass Grafting, also known as CABG. A coronary artery bypass gives blood a new route around a blocked artery. A healthy blood vessel is taken from the chest or leg during surgery. This vessel is connected below the blocked artery. A new pathway improves blood flow to the heart

Let us know more about this surgery in India and how it is transforming people’s lives in India and around the globe. Continue reading to know more about it:

Who are at risk of developing Coronary Artery Disease?

Your chances of developing coronary heart disease increase with age. However, you can also develop it if:
● You smoke
● You are obese
● You have a high-fat diet

Symptoms of Coronary Artery Disease

Symptoms of coronary artery disease may include:
● Chest pain
● Fatigue
● Palpitations
● Abnormal heart rhythms
● Shortness of breath
● Swelling in hands
● Indigestion

Who needs Coronary Artery Bypass surgery?

CABG is done to restore the blood flow around the blocked artery. The surgery is done as an emergency treatment for a heart attack. It may also be recommended in the following situations:

● You have a severe blockage in the left artery as it supplies maximum blood to the heart
● Severe narrowing in the main heart artery
● Severe chest pain
● More than one blocked heart artery
● A blocked heart artery that cannot be treated by angioplasty
● Angioplasty with or without a stent that has not worked.

Imaging and Lab Tests

The potential tests you can undergo before the surgery are:
● ECG or EKG
● Echocardiogram
● Exercise stress test
● Nuclear cardiac stress test
● Cardiac catheterization
● CT scan
● Coronary Calcium Scan

Treatment of Coronary Artery Disease in India: Minimally Invasive Coronary Artery Bypass Surgery ( MICS-CABG)

This is the latest treatment option available in India for treating patients suffering from coronary heart disease. Unlike traditional CABG, it is a specialized coronary artery bypass grafting technique with small incisions and reduced trauma. The different techniques used to perform MICS-CABG in India are:

Direct Coronary Artery Bypass (MIDCAB): MIDCAB involves making a small incision between the ribs on the left side of the chest. Unlike conventional CABG, this doesn’t require splitting the breastbone (sternotomy). The MIDCAB avoids sternotomy, so there is less trauma to the chest, and the patient may recover faster.

Off-Pump Coronary Artery Bypass (OPCAB): This surgical technique can relieve narrowed or blocked coronary arteries and is an alternative to Coronary Artery Bypass Grafts (CABG). Compared to traditional CABG surgery, OPCAB does not use a heart-lung machine.

Robot-Assisted Coronary Artery Bypass Grafting (TECAB): This is an advanced technique used to perform coronary artery bypass grafts (CABGs). It’s a minimally invasive approach using robotics and endoscopic instruments to reach the coronary arteries.

Knowing Minimally Invasive Coronary Artery Bypass Surgery ( MICS-CABG) In Detail

Before the Surgery

● It would help if you underwent a thorough medical evaluation to determine your overall health.
● Any pre-existing medical condition is identified to increase the impact of the surgery.
● You will have an in-depth conversation with your cardiac surgeon to determine the risks and benefits of the surgery.
● Your current medications may be temporarily adjusted or stopped to reduce any complications in the surgery.
● You will be given pre-operative instructions, including fasting before the surgery and avoiding certain medications (potent anticoagulants)
● Please quit smoking and drinking before the surgery to avoid complications.
● The anesthesiologist will discuss the risks associated with anesthesia with you.

During the Surgery

● Anesthesia: During surgery, the patient is given general anesthesia to make sure they’re unconscious
● Minimal Incision: A thoracoscope (a thin, flexible tube with a camera) and specialized instruments are inserted through small incisions in the chest.
● Visualization: The thoracoscope shows the heart and its internal structures on a video monitor in the operating room. This allows the surgeon to see the surgical site clearly and perform the procedure correctly.
● Grafting: The surgeon can use an artery from another body part as the graft, like the internal mammary or radial artery. A small incision in the arm or leg can also harvest the artery endoscopically.
● Closing: Surgeons use specialized instruments to graft the healthy artery onto the blocked coronary artery, creating a new path for blood to flow.
● Once the bypass graft is placed, the surgeon ensures the bypass graft is working, and the blood flow to the heart muscles is back to normal.

After the Surgery

● After the surgery, you will be taken to the ICU.
● You may experience pain after the surgery. Hence an important part of the surgery is pain management.
● You will be closely observed weekly with frequent heart rate, blood pressure, and oxygen level checks.
● After four days, you can start routine activities like sitting in bed, walking short distances, etc.
● Since the incision during the surgery is small, it requires less wound care.
● You can also start cardiovascular rehabilitation after your hospital stay.
● The length of hospital stay is comparatively less in MICS-CABG.
● Follow post-operative instructions by a surgical team once you reach home.
● Individual experiences can vary, so consult your surgeon for a personalized experience.

Long term outcomes

Most patients do well with Minimally Invasive Coronary Artery Bypass Surgery (MICS-CABG). It improves blood flow to blocked or narrowed coronary arteries by revascularizing the heart. Long-term benefits of MICS-CABG include:
● Improves quality of life by improving chest pain and shortness of breath.
● Prevents future heart attacks and strokes by restoring blood flow to the heart and brain.
● It can boost your exercise capacity and cardiovascular health.
● MICS-CABG bypass grafts last for years, so patients get long-lasting benefits.
● It may reduce the need for certain medications to manage coronary artery disease, but patients will still have to take blood pressure and cholesterol medications.
● Early returning to their regular activities, including work, exercise, and hobbies, with the guidance of their healthcare team.

Sites Of Graft in MICS-CABG

The grafts are usually obtained from healthy blood vessels elsewhere in the body. The most common sites of graft in MICS-CABG are:

● Internal Mammary Artery: It is inside the chest and runs parallel to the breastbone.
● Radial Artery: It is located in the forearm and is often used as a graft in MICS-CABG.
● Saphenous Vein: It is a superficial vein located in the left and used in traditional CABG and MICS-CABG.

Arterial Vs. Venous Graft

● Arterial Grafts, particularly the internal mammary artery, have long-term patency rates, leading to improved graft durability and reducing chances of blockage.
● Venous grafts, on the other hand, such as saphenous veins, are easier to harvest and suitable for grafting multiple coronary arteries.

Advantages of Minimally Invasive Cardiac Surgery over the traditional CABG:

● The biggest advantage of this method is that no bones are cut, so there’s less pain and less impact on your breathing.
● Unlike conventional heart surgery, which takes nine days, this procedure takes only five days so that you can return to normal life quicker.
● With less blood loss, you don’t need blood transfusions, and you don’t get blood-borne diseases.
● Patients may not experience post-surgical anemia due to blood loss.
● There’s a big reduction in infection risks due to a small cut. It’s perfect for people with diabetes and older patients with weakened immune systems.
● It leaves a very small scar since the incision is just 2 – 3 inches long

The limitations of minimally invasive cardiac surgery

● It requires specialized surgeons and specialized hospitals since this is a new technique.
● Compared to the traditional CABG, this is more expensive.
● Patients are selected based on strict criteria. This technique isn’t for patients with extensive disease or low heart function.

Endoscopic Vein Harvesting (EVH)

Endoscopic Vein Harvesting refers to harvesting a healthy vein from a patient for coronary artery bypass graft (CABG) surgery. A tiny incision in the leg is used to insert an endoscope (a thin, flexible tube with a camera). An endoscope provides a magnified view of the saphenous Vein’s insides so the surgeon can carefully dissect and remove it. The advantage of this procedure is:
● Small incisions
● Faster recovery
● Reduced risk of complications
● Enhanced visualization
● Improved patient satisfaction

Top Hospitals and Doctor’s doing Coronary Artery Bypass surgery in India