Triple Bypass Surgery by Keyhole

Triple Bypass and Coronary Artery Disease

Coronary artery disease (CAD) is one of the commonest cases of heart disease and shorter life expectancy in the world today. CAD leads to blocked or narrowed arteries, which restrict blood flow to the heart muscle. In severe cases, individuals may require a coronary artery bypass graft (CABG) surgery, often known as a bypass surgery, to restore proper blood circulation. Among these procedures, a triple bypass surgery is a complex yet life-saving intervention.

Triple bypass surgery involves creating new pathways for blood to flow to the heart muscle by using healthy blood vessels from other parts of the body to create “flyovers” which redirect blood past the blockages in order to deliver oxygen to the heart. The procedure is generally performed through a traditional open-heart surgery approach, involving a large incision through the breastbone which allows direct access to the heart. While highly effective, this invasive technique can be accompanied by extended recovery times, increased risk of complications, and potential discomfort for the patient.

Triple Bypass Surgery and Minimally Invasive Direct Coronary Bypass

The good news is that the landscape of cardiac surgery has been revolutionised by the advent of minimally invasive direct coronary bypass (MIDCAB) procedures, also known as  keyhole heart surgery, which presents a more refined and less invasive approach to coronary artery bypass.

MIDCAB involves the use of smaller incisions on the chest, through which a specialised camera and instruments are inserted to access the heart to bypass an artery on the front of the heart called the left anterior descending artery. In comparison to the traditional open-heart surgery, this technique offers several advantages for patients undergoing a triple bypass:

1. Reduced Trauma: Smaller incisions lead to less trauma to the chest and tissues, resulting in reduced pain and discomfort, and a quicker recovery period.
2. Lesser Scarring: The smaller incisions result in minimal scarring, improving the aesthetic outcome and potentially boosting the patient’s confidence.
3. Quicker Recovery: Patients often experience shorter hospital stays and faster recuperation times, enabling a swifter return to their normal daily activities.
4. Lower Risk of Infection: The reduced exposure of internal tissues and smaller incisions contribute to a decreased risk of postoperative infections.
5. Comparable Efficacy: Studies suggest that keyhole heart surgery for bypass procedures yields comparable outcomes to traditional open-heart surgery, with similar success rates and long-term results.
   

Total Coronary Revascularisation via Left Anterior Thoracotomy (TCRAT)

Some surgeons, like our lead heart surgeon Mr Inderpaul Birdi, can bypass more than one artery using an operation called Total Coronary Revascularisation by left Anterior Thoracotomy (TCRAT). TCRAT is a highly skilled but effective operation which involves grafting all of the blocked arteries in one surgery through a small keyhole cut between the ribs over the left chest. Mr Birdi says:

“We have performed double, triple and even quadruple bypass surgery routinely for several years and are always surprised when patients tell us that their doctors say it is impossible. It is absolutely safe and effective when performed in the right patients by an experienced minimally invasive team”. 

It’s crucial to note that not all patients are candidates forTCRAT and the decision for this approach depends on various factors, including the patient’s overall health, the complexity of the bypass needed, and the expertise of the surgical team.

The evolution of cardiac surgery has brought about a transformative change with the introduction of keyhole heart surgery for triple bypass procedures. As technology advances and surgical techniques improve, TCRAT is poised to become more prevalent, offering a promising alternative to the conventional open-heart surgery.

In conclusion, triple bypass surgery stands as a crucial intervention for individuals affected by severe coronary artery disease. The introduction of keyhole heart surgery in the form of MIDCAB and TCART has opened new horizons for less invasive incisions that avoid breastbone division to allow quicker recovery, less pain, and smaller scars.