Minimally invasive direct coronary artery bypass (MIDCAB) is a surgical treatment for

coronary heart disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves Ischemia, the reduction of blood flow to the myocardium, heart muscle due to build-up o ...

that is a less invasive method of

coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pai ...

(CABG). MIDCAB gains surgical access to the heart with a smaller

incision Incision may refer to: * Cutting, the separation of an object, into two or more portions, through the application of an acutely directed force * A type of open wound caused by a clean, sharp-edged object such as a knife, razor, or glass splinter * ...

than other types of CABG. MIDCAB is sometimes referred to as "keyhole"

heart surgery Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to c ...

because the operation is analogous to operating through a

keyhole A lock is a mechanical or electronic fastening device that is released by a physical object (such as a key, keycard, fingerprint, RFID card, security token or coin), by supplying secret information (such as a number or letter permutation or passw ...

. MIDCAB is a form of

off-pump coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pai ...

(OPCAB), performed "off-pump" – without the use of

cardiopulmonary bypass Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a ...

(the heart-lung machine). MIDCAB differs from OPCAB in the type of incision used for the surgery; with traditional CABG and OPCAB a

median sternotomy Median sternotomy is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided using a sternal saw. This procedure provides access to the heart and lungs for surgical proc ...

(dividing the

breastbone The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury ...

) provides access to the heart; with MIDCAB, the surgeon enters the chest cavity through a

mini-thoracotomy A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the h ...

(a 2-to-3 inch incision between the ribs). MIDCAB surgery is no longer reserved for only anteriorly placed single- or double-vessel diseases, because such lesions are usually managed with

angioplasty Angioplasty, is also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclero ...

. The surgery has recently begun to be used in multi-vessel coronary disease.

MIDCAB in hybrid revascularization

People with multi-vessel coronary disease, who desire a minimally invasive approach to surgery may be eligible for hybrid bypass. A hybrid approach combines coronary bypass (using the MIDCAB approach) and coronary

stenting In medicine, a stent is a metal or plastic tube inserted into the lumen of an anatomic vessel or duct to keep the passageway open, and stenting is the placement of a stent. A wide variety of stents are used for different purposes, from expanda ...

References

{{DEFAULTSORT:Minimally Invasive Direct Coronary Artery Bypass Surgery Cardiac surgery Minimally-invasive surgery

MIDCAB in hybrid revascularization

See also

References