Keyhole Coronary Artery Surgery

This procedure, also known as Minimally Invasive Direct Coronary Artery Revascularisation (MIDCAB), is performed via a left minithoracotomy incision on the beating heart. The procedure is an excellent therapy when performed by surgeons with experience in both keyhole surgery and beating heart surgery. It is most commonly used in patients with isolated disease of the Left Anterior Descending Artery (LAD) a very important branch of the left coronary artery. It is also possible to graft more than one vessel using this technique in highly selected patients.

Here is a diagram to simplify the differences between traditional and minimally invasive approaches:

Traditional Breastbone Division
Broken bone
Heals in 3 months
No heavy lifting for 12 weeks
Small risk of bone infection
Mild to moderate pain
Cosmetically less appealing

Keyhole Approach
No broken bone
Heals within 7 days
Resume activity within days
No bone infection risk
Minimal pain
Superior cosmetic appeal

Hybrid keyhole coronary artery surgery

Although multiple bypass grafts can be performed via keyhole openings in carefully selected patients, the mainstay of 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 patient’s 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 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.

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 aim being to avoid breastbone division.

Until recently, little was known about the immediate and long-term outcomes of this approach. In a recent article to be 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

Hybrid therapies can be used to treat coronary disease and valve disease through keyhole techniques. Contact us to learn more about these treatments.

In some patients with multi-vessel coronary disease, the entire procedure can be performed by keyhole heart surgery. This can only be performed in selected patients by highly experienced keyhole heart surgery teams. Call us if you wish to know more.

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Wed 28 June 2017

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