Cardiac Surgery

MICS CABG (minimally invasive cardiac surgery/coronary artery bypass grafting) The McGinn Technique

MICS CABG (pronounced mix cabbage), is an "off-pump," multi-vessel coronary artery bypass surgery pioneered and perfected at The Heart Institute. This groundbreaking technique is much less invasive than traditional bypass surgery, in that, the procedure is performed through three small incisions and without having to break ribs or the breastbone. In traditional bypass surgery, the breastbone is broken and a large sternotomy incision is made midline on the chest.

MICS CABG is often called The McGinn Technique — named for its pioneer, Dr. Joseph McGinn, renowned cardiothoracic surgeon and Medical Director of The Heart Institute.

Benefits of MICS CABG include:

• 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 (only three small incisions to heal)

How is MICS CABG performed?

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.

How does MICS CABG differ from traditional bypass surgery?

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 "off-pump" 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 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.

What can I expect before the procedure?

Prior to surgery, you will meet with the surgeon so he can evaluate your condition and explain the surgery in detail. You may also be introduced to our Nurse Navigator at the time of consultation. She will help you with anything you may need and answer any questions you may have. This meeting will run through the expectations, risks and outcomes.

You will be given instructions to follow prior to the procedure. You may need to stop certain medications and be scheduled for additional testing. This will all be decided by the surgeon once you are interviewed.

You will also need to go to presurgical testing for routine blood tests, a chest X-ray, an EKG and a full examination.

What can I expect upon arriving at The Heart Institute?

Upon arrival at THI, you will be greeted by our nursing staff who will help to get you prepared for the procedure, and provide you with a medical gown. Before you are moved to the cardiac laboratory, you will be briefed by the surgical physician and the anesthesiologist.

The operation is fairly extensive, so your doctor will take the time to explain the operation carefully to you to ensure you understand the procedure, its risks, and your likely outcomes.

What happens after the procedure?

You will be sent to the cardiothoracic intensive care unit (CTU) after the operation to monitor your progress.

For the 24 hours following, you will be administered an intravenous pain pump and fitted with drains. Post-operative discomfort for MICS CABG is greatly reduced compared to the traditional bypass approach, which can be quite traumatic for the patient.

Once you are dismissed from intensive care, your recovery will be rapid. It is expected that you will be on your feet and back to your daily routine within days rather than weeks or months as it is with traditional bypass surgery.

Who needs MICS CABG?

• Patients diagnosed with coronary artery disease
• Patients who have had previous unsuccessful stenting
• Patients with severe symptoms that can no longer be controlled with medication or angioplasty (stenting)

MICS CABG may also be beneficial to individuals with comorbidities such as advanced age, long-term steroid use, severe COPD (coronary obstructive pulmonary disease), severe reconditioning, or patients with arthritic or orthopedic problems.

Patients who have previously undergone major surgery with advanced peripheral vascular disease or morbid obesity may not qualify for the MICS CABG procedure.

Who is not eligible for MICS CABG?

Patients with certain conditions will not be considered suitable for surgery because of the risks involved. Possible contraindications include:

• Emergency cases
• Hemodynamic instability
• Morbid obesity
• Posterolateral branch disease
• EF < 20%
• Peripheral vascular disease (PVD)
• Dilated cardiomyopathy
• Pectus excavatum

Minimally Invasive Heart Valve Surgery

Recent advancements in cardiac surgery have given cardiac surgeons the ability to repair or replace heart valves through small incisions. These pioneering efforts and perfected technology have allowed the surgical team at The Heart Institute to perform aortic valve replacement, mitral valve repair, mitral valve replacement, repairs of atrial and ventricular septal defects, and excision of cardiac tumors via this innovative approach. Mitral valve repair is the primary method of treatment for mitral valve disease at The Heart Institute. Some patients who have undergone this type of surgery have gone home in three days post-procedure, enabling a quick return to an active lifestyle.

Thoracic Aortic Aneurysm

The aorta is the largest artery in the body, which runs from your heart through the center of your chest and abdomen. It is a blood vessel that carries oxygen-rich blood from the heart to all parts of the body. An aneurysm forms when there is weakness in the artery wall. As blood pumps through the weakened artery, the wall abnormally expands or bulges. Complications include rupture and blood clots. A ruptured thoracic aortic aneurysm can cause bleeding which can be life threatening. Blood clots can dislodge causing blocked blood flow to other parts of your body like the brain, legs or organs.

Aneurysms can be small and slow growing and never rupture. But, large, fast growing aneurysms require careful monitoring to prevent rupture. Treatment of thoracic aneurysms may vary and depends on the size, location and overall health of the individual. When an aneurysm is large and causing symptoms, surgery may be indicated in order to prevent it from rupturing.

Risk factors for thoracic aortic aneurysm include age (over 60), tobacco use, uncontrolled high blood pressure, build up of plaque in the arteries, gender (males), family history, aortic valve disease and Marfan’s Syndrome (connective tissue disease). Symptoms include tenderness or pain in the chest and back pain. You should speak to your doctor if you have any of these symptoms or risk factors.

Surgical repair of thoracic aortic aneurysms is complex and can require urgent or emergent attention. The standard surgical treatment performed at The Heart Institute by our highly experienced staff is an open chest procedure. The weakened section of the vessel is surgically removed and replaced with a graft made of artificial material. Like any other open chest procedure, recovery will take about 6-8 weeks.