Minimally Invasive Direct Coronary Artery Bypass
For the appropriate candidates, the University of Maryland Heart Center offers a minimally invasive surgical approach to treating blockages in the coronary arteries, known as minimally invasive direct coronary artery bypass, or MIDCAB.
What is MIDCAB?
In contrast to open-heart bypass surgery where the chest is cut open at the sternum to gain access to the heart, the surgeon creates a tiny, two-and-a-half inch opening between two ribs in the left side of the chest. The surgeon then harvests the internal mammary artery from the chest. This is done directly or with the use of the surgical robot. The surgeon then sutures the internal mammary artery to the coronary arteries through this keyhole-size opening. This suturing is performed while the heart is still beating.
This operation is chosen if use of the heart-lung machine is regarded as too risky. This may be the case in patients with additional diseases like chronic pulmonary disease, peripheral vascular disease and kidney failure.
What are other advantages this approach offers to patients?
This approach offers many advantages to patients, including:
- Quicker recovery times
- Decreased need for blood transfusion
- No manipulation of the ascending aorta that could cause neurologic injury
Who are good candidates for this procedure?
The MIDCAB procedure can be used on patients who have blockages that are accessible to bypass through a small incision in the left chest. This depends on the pattern of blockages present in the coronary arteries that are seen in the angiogram, which is performed prior to being referred for surgery. If the blockages are present only on the vessels on the left side of the heart, then most likely the patient is a candidate.
The MIDCAB procedure can be combined with catheter-based intervention on the coronary arteries in the hybrid procedure. This procedure involves stenting these right-sided blockages at the same time as the surgical bypass.
How long is the typical hospital stay compared to open heart surgery?
In our experience, the average length of stay is reduced by two days for the MIDCAB procedure.
Are many cardiac surgeons performing this procedure?
Because this procedure requires specialized skills, it is only performed by a few cardiac surgeons around the country, including surgeons at the University of Maryland Heart Center. Our access to and expertise with surgical robots facilitates this technically challenging operation.
Please call if you would like to make an appointment or talk to someone about our services. Patients dial 1-866-408-6885, physicians dial 410-328-6622 or 1-800-318-1019.
This page was last updated: February 4, 2014