Coronary Artery Bypass Grafting

Coronary Artery Bypass Grafting (CABG), is an option for some patients who require a left internal mammary artery bypass graft to the left anterior descending artery. A small, 2-3 inch incision is made in the chest wall between the ribs.

Off-pump or beating heart bypass surgery allows surgeons to perform surgery on the heart while it is still beating. A medication may be given to slow the heart during surgery, but the heart keeps beating during the procedure. This type of surgery may be an option for patients with single-vessel disease (such as disease of the left anterior descending artery or right coronary artery).

Traditionally, CABG surgery is performed with the assistance of cardiopulmonary bypass (heart-lung machine). The heart-lung machine allows the heart beating to be stopped, so the surgeon can operate on a surface which is blood-free and still. The heart-lung machine maintains life despite the lack of a heartbeat, removing carbon dioxide from the blood and replacing it with oxygen before pumping it around the body.

During off-pump or beating heart surgery, the heart-lung machine is not used. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body.

Who is a candidate for minimally invasive heart surgery?

Your cardiac surgeon will review the results of your diagnostic tests before your scheduled surgery to determine if you are a candidate for minimally invasive surgery. The surgical team will carefully weigh the advantages and disadvantages of minimally invasive heart surgery against traditional surgery. The endovascular cardiopulmonary bypass system is not recommended for use in patients with moderate to severe aortic atherosclerosis, aneurysm of the ascending aorta, severe aortic valve regurgitation and in certain cases moderate to severe peripheral atherosclerosis.

How will I feel after minimally invasive heart surgery?

There will be some incision discomfort for the first few days after surgery. Medications can be taken to help relieve this discomfort. If you begin to have the same discomfort in your chest that is similar to the symptoms you had before your surgery, call your local A& E or GP.

What the recovery after minimally invasive heart surgery?

Patients who had minimally invasive surgery may be able to go home 3 to 4 days after surgery. You will be given a discharge talk and contact numbers in case of any queries. You will be called for a follow up appointment after 6-8 weeks of your surgery. You can then attend your local cardiac rehabilitation programme. Your cardiac rehabilitation team will provide specific instructions for your recovery and return to work, including guidelines for activity, driving, incision care and diet.

In general, you may be able to return to work (if you have a sedentary job), resume driving and participate in most non-strenuous activities within 2 to 4 weeks after minimally invasive heart surgery. You can resume heavy lifting and other more strenuous activities within 6 to 8 weeks after minimally invasive surgery.

Have the outcomes been assessed?

There is an International Registry which has collected data from over 2,386 operations using the endovascular cardiopulmonary bypass system. The 30 day mortality and morbidity are comparable to those of conventional cardiac operations.

The outcomes of the first 1063 patients reported to the registry concluded that “Port Access CABG and mitral surgery can be performed safely, with morbidity and mortality outcomes similar to open chest methods.”

There are published NICE guidelines on Minimally invasive mitral valve and coronary artery bypass surgery. NICE has recently published guidelines for use of intra-aortic endoclamp balloon catheter.