Minimally invasive cardiac bypass surgery/coronary artery bypass grafting (MICS CABG)
What is MICS CABG?
Minimally invasive cardiac surgery/coronary artery bypass grafting, or MICS CABG (pronounced mix cabbage), is an "Off-pump," multi-vessel coronary artery bypass surgery. It is much less invasive than traditional bypass surgery, in that, the surgery is performed through three small incisions rather than the typical sternotomy incision. The first incision, also known as the window incision, is approximately 2" in length. The second and third incisions act as access ports and are approximately 1" in length. The Anastomoses are performed under direct vision through the lateral mini-Thoracotomy. The internal mammary artery (IMA) takedown can be performed under direct vision, with video assistance, or robotically. Additionally, in order to achieve complete revascularization, a pump-assisted, beating-heart approach can be employed. The surgery is performed without breaking ribs or the breastbone.
The Many Benefits of MICS CABG
- Less pain (no broken bones)
- Lower risk of wound infection
- Fewer restrictions, including no driving restrictions
- Faster recovery, many patients discharged from the hospital within two to three days and can return to work within two weeks
- Improved cosmetic outcome
Patient Selection
- Advanced age
- Long-term steroid use
- Severe COPD (Chronic Obstructive Pulmonary Disease)
- Severe deconditionings
- Need for other major operative procedure
- Patients with severe arthritic or orthopedic problems
Contraindication
- Reoperations
- Urgent or emergent cases
- Advanced peripheral vascular disease
- Morbid obesity
Volume of procedures
MICS CABG is much less invasive than traditional bypass surgery, in that, the surgery is performed through three small incisions and without breaking the ribs or the breastbone.
MICS CABG FAQ
Q: What is the difference between traditional open heart surgery and minimally invasive cardiac surgery/coronary artery bypass grafting?
A:
To reach the heart in traditional bypass surgery, a sternotomy incision, approximately 6"–8" in length, is made midline on the chest and through the breastbone. It can be performed as "off-pump" surgery or, if necessary, the heart can be stopped and a heart-lung machine is used to help maintain the circulation of blood and oxygen content of the body.
Upon completing the traditional open heart surgery, the breastbone is wired together and then the sternotomy incision closed. It is a highly invasive process with a long recovery phase. Postsurgery complications are not uncommon in the traditional open heart method.
In comparison, MICS CABG is performed via three small incisions on the chest, approximately 1"–2" in length, and without having to break the ribs or the breastbone. With small incisions and no broken bones to heal, postsurgery complications are not typical and patients usually see a full recovery within the month after surgery.
Q: What does MICS CABG stand for?
A:
MICS CABG — pronounced mix cabbage — is short for minimally invasive cardiac surgery/coronary artery bypass grafting.
Q:What are the benefits of MICS CABG?
A:
- Less pain (no broken bones)
- Lower risk of wound infection
- Fewer restrictions, including no driving restrictions
- Faster recovery, many patients are discharged from the hospital within two to three days and can return to work within two weeks
- Improved cosmetic outcome
Q:Who is a candidate for MICS CABG?
A:
MICS CABG can be performed on most patients who need bypass surgery. The following criteria are just a few reasons why it may be right for you:
- Advanced age
- Long-term steroid use
- Severe COPD (Chronic Obstructive Pulmonary Disease)
- Severe deconditioning
- Need for other major operative procedure
- Patients with severe arthritic or orthopedic problems
Q:Is MICS CABG considered experimental heart surgery?
A:
No. Since developing the technique in 2005, Dr. McGinn has performed hundreds of MICS CABG procedures with an exceptional success rate.
Q:Why don't more doctors know about/perform this procedure?
A:
MICS CABG is a relatively new, advanced technique that most physicians have not been trained to perform. Although we do offer ongoing, peer-to-peer training sessions led by Dr. McGinn, only a handful of physicians perform the procedure worldwide.
Q:What is the history of MICS CABG?
A:
The first MICS CABG was performed on January 21, 2005, at The Heart Institute by a highly trained team led by Dr. Joseph McGinn. This technique, where proximal grafts were anastomosed to the mammary artery, was performed for two years with a favorable outcome. After taking this procedure to Japan and listening to feedback from his peers, Dr. McGinn felt the procedure could be improved. Today, surgeons can have direct visibility of the aorta through the window incision allowing for proximal anastomosis to be performed on the aorta.
Q:Is MICS CABG recommended for more complicated (double, triple and quadruple) bypass surgeries?
A:
In most cases the answer is yes, but the patient needs to be evaluated on an individual basis.
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"Learn about MICS CABG, the technique that has us at the forefront of minimally invasive bypass surgery."