What Is Minimally Invasive Coronary Artery Bypass Surgery?

Traditional coronary artery bypass grafting surgery requires splitting the chest open, literally cutting through the breastbone. This can lead to a traumatic and painful recovery.

The University of Maryland Heart Center offers cutting-edge robotic-assisted surgery, that requires no incisions, thus greatly reducing post-operative recovery. Our coronary artery bypass surgery program is directed by Dr. Johannes Bonatti, who is recognized as one of the world's most experienced surgeons in minimally invasive coronary operations using the da Vinci robot.

We specialize -- and have helped pioneer -- minimally invasive techniques, which enable patients to recover and return to normal activities much faster with fewer side effects compared to traditional operations that require a large incision. We offer multiple forms of minimally invasive coronary artery bypass surgery -- TECAB, MIDCAB and Hybrid Coronary Intervention.

Totally Endoscopic Minimally Invasive Coronary Artery Bypass Surgery

Also known as TECAB, this form of surgery utilizes a state-of-the-art surgical robot to allow the surgeon to perform this precise procedure without an incision; it is the least invasive form of coronary artery bypass surgery available. Unlike other forms of bypass grafting, where the surgery requires cracking open the chest, or at least passing through small openings, this surgery is completed entirely through tiny holes. In TECAB, a graft is inserted through very small holes without any need to cut into or open the patient's chest, which reduces the patient’s hospital stay, recovery time, bleeding, scarring and length of time needed to resume normal activities.

When performing a TECAB procedure, the surgeon uses an advanced surgical robot in order to accomplish very precise movements inside the patient's chest. The University of Maryland Heart Center uses the da Vinci system, which provides additional benefits over laparoscopic surgery, such as 3-D images of the surgical area, 10x magnification, steady robotic arms that remove hand tremors, and robotic wrists which allow the device to pivot 540 degrees. This surgeon-directed robot allows for incredibly precise movements that are physically impossible for a human alone.

The patient is connected to a heart-lung machine throughout the surgery via a small incision in the groin. The machine takes over circulating the patient’s blood while the heart is stopped for surgery. With both the heart-lung machine and the robot, the surgeon is able to make exact repairs on vessels as small as 2 millimeters in diameter.

What is TECAB Recovery Like?

Patients who undergo totally endoscopic minimally invasive coronary artery bypass surgery remain in the hospital for four to five days, compared to several weeks for traditional open heart surgery. TECAB patients tend to be able to eat and walk quickly after surgery. Immediately following the operation, patients do spend some time in an intensive care unit for monitoring as they remain on the ventilator for several hours to diagnose adequate heart functioning.

What are the Advantages of TECAB

Because there is no large incision, trauma to the patient is greatly reduced. Other potential patient benefits of TECAB as compared to traditional surgery include:

• Less pain (and need for pain medication)
• Less scarring
• Shorter hospital stay
• Quicker recovery and return to normal activities, even light sports, within two to three weeks after the intervention.
• Less bleeding and need for blood transfusions
• Lower risk of infection
• The Bypass grafts that are used can stay open and supply the heart with blood for a very long time. These so-called internal mammary arteries show durability rates in the 20 to 30 year range and are the best option for patients with coronary artery disease.
• No foreign material is implanted.
• Except for aspirin, which patients with coronary artery disease have to take anyway, no blood-thinning medication is necessary.

Minimally Invasive Direct Coronary Artery Bypass

Also known as MIDCAB, this procedure allows the surgeon to perform the bypass by only creating a small 2.5-inch incision on the left side of the chest in between 2 ribs. Using the da Vinci robot, the surgeon is able to "harvest" a single mammary artery, which will then be sutured to the coronary arteries through this incision. The heart remains beating throughout the entire process. Only a handful of cardiac surgeons in the country are able to perform this procedure. The use of robotic assistance at the Maryland Heart Center makes UMMC one of the few institutions able to perform this technically challenging, but ultimately rewarding, procedure.

What are the Advantages of MIDCAB

MIDCAB patients see quicker recovery times than those who undergo traditional coronary artery bypass surgery. There is also a decreased likelihood of a blood transfusion and neurologic injury.

Who are Good Candidates for MIDCAB?

If the patient's blockages are available through the left chest incision for bypass, they are more likely to be candidates for MIDCAB. When an angiogram is performed before the surgery, the surgeon will be able to determine if the pattern of the blockages meet this criteria.

What is MIDCAB Recovery Like?

MIDCAB patients are likely to spend 2 fewer days in the hospital that traditional coronary artery bypass surgery patients. Pain is also significantly reduced in comparison to the traditional surgery, which requires cutting open the chest at the sternum.

Hybrid Coronary Intervention

The University of Maryland Medical Center was one of the first institutions to perform the combined procedure of minimally invasive coronary artery bypass surgery and PTCA (catheter-based coronary intervention). Historically, these procedures would be performed separately, thus requiring two surgeries. However, in this procedure, the bypass surgery occurs first, allowing the other vessels to be stented. After this first part of the surgery, angioplasty is used to restore blood flow in the arteries that do not require a bypass. Using medication-coated stents prevents future reblocking as well.

What are the Advantages of the Hybrid Method?

There are many benefits to this procedure. The number of days a patient is required to stay in the hospital are limited, the less-invasive procedure increases the likelihood of long-term success, the procedure is both less stressful and more convenient, and the procedure is carried out in the security of a state-of-the-art cardiac surgery operating room.

Who are Good Candidates for the Hybrid Procedure?

The only primary qualification for the hybrid procedure is that the candidate's blockages be in the left anterior descending artery.