Avoiding a breastbone cut hybrid coronary bypass surgery

Mon 10 April 2017

FAQ:ARE THERE ANY ALTERNATIVES THAT ALLOW ME TO AVOID BREASTBONE DIVISION IF I NEED BYPASS SURGERY?

Traditional coronary bypass surgery through the breastbone is a safe and effective treatment with fantastic long term results. The team at The Keyhole Heart Clinic perform this procedure routinely on a day to day basis. In certain circumstances, however, we can also perform Keyhole Coronary Artery Bypass Surgery with the potential for much quicker recovery postoperatively.

Until more recently, keyhole coronary bypass surgery has been restricted to those patients with single vessel disease involving a major artery on the front of the heart called the LAD (left anterior descending artery). In these patients we can perform a procedure called Minimally Invasive Direct Coronary Artery Bypass Surgery (MIDCAB). This involves surgery on the beating heart via a small opening placed between the ribs on the front of the left chest. There is no doubt that surgical revascularisation of this particular vessel offers a much better long-term clinical outcome compared to stenting of the artery, and the recovery from MIDCAB in experienced hands offers significantly reduced hospital stay, with healing within days rather than weeks when compared with traditional surgery through the breastbone cut.

In order to widen the benefits of keyhole revascularisation, a therapy called Hybrid coronary artery bypass grafting can be offered to some patients. This treatment involves two procedures performed either on separate occasions or at the same time, which is designed to offer the superior benefits of revascularisation of the LAD via the MIDCAB opening, followed by treatment of any remaining narrowed arteries using stents, the ultimate aim being to avoid breastbone division.

In a recent article to published in The Journal of the American College of Surgeons, Hybrid Coronary Revascularisation was compared with traditional multi-vessel bypass grafting via breastbone division.

Hybrid coronary revascularisation was associated with:

– Reduced rates of in-hospital major morbidity

– Reduced blood transfusion use

– Reduced chest tube drainage (blood loss)

– Reduced postoperative length of stay

Finally, over a 3-year follow-up of all patients, there were no demonstrated advantages of traditional surgery over Hybrid Coronary Revascularisation

The authors concluded that the use of hybrid coronary revascularisation appeared to be safe, with faster recovery and similar outcomes when compared with conventional CABG. These findings were consistent irrespective of anatomic or predicted procedural risk.

I am certain that Hybrid approaches to CABG will increase in the future. The caveat must be to construct a perfect surgical  bypass graft. Experienced teams are therefore essential to ensure excellent clinical results.

Comparative Effectiveness of Hybrid Coronary Revascularization vs Coronary Artery Bypass Grafting :

http://dx.doi.org/10.1016/j.jamcollsurg.2015.03.012


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