Coronary Artery Bypass Grafting (CABG) has long been a gold standard for treating coronary artery disease (CAD). Traditionally, CABG involves a sternotomy- a large incision through the breastbone to access the heart. While highly effective, this approach is invasive, comes with extended recovery periods (approximately 3 months), and carries a risk of complications - more pain, blood loss, and sternal wound dehiscence/breakdown. Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG)- a breakthrough technique that offers the benefits of bypass surgery while minimizing the trauma associated with traditional methods.

What is MICS CABG?

MICS CABG is a type of heart surgery for bypassing blocked arteries without the need for a full sternotomy. Instead of opening the entire chest, the surgeon makes a small incision (typically between 5-7 cm) on the left side of the chest, between the ribs. Using this incision, specialized instruments are used to perform the bypass procedure.

This method is performed under direct vision, meaning the surgeon can see the heart and the arteries but without the need for splitting the breastbone. The internal mammary artery or a vein from the leg or a radial artery from the left forearm is typically used to bypass the blocked artery, just as in traditional CABG.

Usually vein from the leg or Radial artery from the forearm is taken with the help of an endoscope (EVH Technique) which requires only a 2-3 cm long incision (surgical wound). It significantly reduces pain and blood loss/wound-related complications when compared to conventional surgery

Key Advantages of MICS CABG for Heart Bypass Surgery

• Less Invasive: The most significant benefit of MICS CABG is that it avoids the large sternotomy incision. This results in less trauma to the chest wall and less disruption to the skeletal system.
• Faster Recovery Time: Without the need to break the breastbone, patients can often return to normal activities much quicker. Many patients are discharged from the hospital within a few days and can resume their daily routines in a few weeks compared to months of recovery following traditional CABG.
• Reduced Pain and Scarring: The smaller incision leads to less post-operative pain and smaller scars, which is a major concern for many patients.
• Lower Risk of Complications: Since there is no sternotomy, the risk of infection and complications related to bone healing is significantly reduced. The reduced trauma also leads to lower instances of post-operative bleeding.
• Better Aesthetic Results: A smaller incision on the side of the chest, often hidden under the breast or near the ribs, leads to a more cosmetically pleasing outcome, which can be important for patients concerned about visible scars in the front of the chest.

Procedure for minimally invasive CABG

MICS CABG is typically performed while the heart continues to beat (off-pump).

Here's a step-by-step overview of the MICS CABG procedure:

• Preoperative Planning: Detailed imaging is performed before surgery to identify the exact location and severity of the blockages in the coronary arteries.
• Small Incision: A small incision (usually 5-7 cm) is made on the left side of the chest, between the ribs.
• Grafting: The surgeon uses specialized tools to bypass the blocked arteries. Healthy vessels (commonly the internal mammary artery or saphenous vein/Radial artery) are grafted onto the coronary arteries to create a new pathway for blood flow.
• Off-Pump Surgery: Unlike conventional CABG, MICS CABG can be performed on a beating heart, eliminating the need for a heart-lung machine, which reduces potential complications associated with stopping the heart.
• Closure: After the grafting is complete, the incisions are closed, and the patient is moved to recovery.
• The patient is usually extubated (removed from the ventilator and sedation) in a few hours.

Who is a Candidate for MICS CABG?

Not all patients are candidates for MICS CABG. Ideal candidates typically include:

• Patients with single or two-vessel coronary artery disease.
• Patients with multiple blocks but otherwise healthy coronary arteries
• Those who have good overall health and are not very obese.
• Patients who may not be suitable for full sternotomy due to other medical conditions.
• Those who have a preference for minimally invasive techniques and understand the risks involved.
• Patients with multiple complex blockages or those requiring more extensive revascularization may still need conventional CABG.

Risks and Limitations of MICS CABG

• While MICS CABG offers many advantages, it is not without risks. Potential complications can include bleeding, infection, or issues with the grafts , though these risks are similar to traditional CABG.
• When compared to conventional heart surgery, MICS CABG is more costly because it requires specialised instruments.
• Additionally, this technique requires a highly skilled surgeon trained in minimally invasive techniques, and it may not be available in all medical centers.

Future of MICS CABG

As technology continues to advance, the future of MICS CABG looks promising. Robotic-assisted MICS CABG, for instance, allows even greater precision and could make this technique accessible to more patients. The growing popularity of minimally invasive surgery across all medical fields is pushing innovation in cardiovascular surgery as well, with a focus on improving patient outcomes and reducing the overall impact of surgery on the body.

MICS CABG represents a significant leap forward in the treatment of coronary artery disease, offering a less invasive, safer, and more comfortable alternative to traditional open-heart surgery. While not all patients will qualify for this technique, those who do can benefit from faster recovery times, reduced pain, and a quicker return to daily life. As this procedure continues to evolve, it holds the potential to become a standard in cardiovascular care for the future.

For patients facing coronary bypass surgery, MICS CABG is certainly an option worth discussing with their healthcare provider. At Amrita Hospital we have best in class Department of Cardiovascular and Thoracic Surgery with specialised doctors and advanced facilities in India. Connect with our department for more details.