Coronary Artery Bypass Graft (CABG) - Open Heart Vs Minimally Invasive

Cardiac Surgeries

Coronary Artery Bypass Graft, the most commonly performed heart surgery is done as
both conventional Open Heart Surgery as well as a minimally invasive surgery.
In Comparison to the conventional Open Heart Surgery, the advanced treatment
technique – minimally invasive Cardiac Surgery is on a rise for treating various heart
ailments.

Coronary Artery Bypass Graft is performed in conditions such as Arteriosclerosis

(atherosclerosis), Coronary Artery Disease (CAD), any occlusion (obstruction) or for any
diseased arteries. CABG involves bypassing blockages in coronary arteries with a blood
vessel taken from another part of the patient's body. The bypass reroutes the blood flow
by bypassing the diseased tissue and providing uninterrupted blood flow to the heart.

Open Heart Bypass Surgery which is the conventional Cardiac Bypass Surgery
involves performing an incision or cut over the sternum and dividing it to reach the heart.
The graft is taken from Great Saphenous Vein from the patient’s leg for the bypass
procedure. Now-a-days Internal Mammary Arteries are the treatment of choice for the
graft because it remains far longer unobstructed as compared to Greater Saphenous vein.
The salient feature involved in this surgery is the use of a Heart-Lung Machine which
provides an uninterrupted circulation and oxygenation to the blood while the heart is
stopped during the surgery. On completion of the bypass surgery the heart is restarted and
the chest wall is closed. The patient is removed from the heart-lung machine. The total
hospital stay of 7-10 days is expected with an Open Heart Surgery.

Minimally Invasive Cardiac Bypass Surgery, the latest treatment technique for
performing Coronary Artery Bypass Graft is the advanced treatment technique which
involves invasion onto the chest wall through a small incision. The procedure is
commonly known as Key-hole Heart Surgery. The peculiar feature of this surgery is that
a very small incision is made on the chest wall and within the confined space the heart is
beating without the use of a lung-heart machine. The technique is used for the
pathologies involved in the Left Anterior Descending Artery and Right Coronary Artery.
For bypass, Internal Mammary Artery is used. This technique has a fewer complications
and the recovery period is around 12-24 hours and the hospital stay is usually about 3-4
days.

On - Pump Vs Off – Pump Cardiac Surgery

While performing a CABG, when the surgeons use Heart-Lung Machine, then it is called
On-Pump CABG. The rationale for using this machine is providing blood supply to the
rest of the body when heart is stopped. This machine does the work of a heart and lung.
The cannulas are placed in the heart to drain the impure blood to the pump where it is
purified and pumped back into the patient. This works even when the heart is stopped
with specialized medications and is still nourished. During this time the grafts are
constructed and at the end of the procedure the heart is restarted. When the adequate
function has been resumed, the bypass machine is disconnected and the pipes are
withdrawn from the heart.

An Off Pump CABG is the newer method of performing CABG. It is performed so as to

keep heart beating and without the use of heart-lung machine. The technique involves
attaching new grafts to the heart while it is constantly moving and filled with the blood.
Special devices are used to stabilize the heart. This technique is a newly evolved
technique to reduce the risks involved with an Open heart surgery such as stroke and
decrease in higher mental functions.

Open Heart Surgery Vs Minimally Invasive Cardiac Surgery – The differences

• Whereas the conventional CABG surgery requires a 10"-12" incision to separate the
sternum, MIDCAB surgery requires either a 3"-5" incision placed between the ribs, or
may be done with several small incisions.
• The CABG is an on pump procedure & thus requires a heart lung machine, while the
MIDCAB is a beating heart surgery & does not require the heart lung machine.
• MICAB surgery is more economical, results in a faster recovery, has fewer
complications, and causes less pain after surgery.
• The procedure is mostly indicated when only 1-2 arteries are involved, unlike the
conventional CABG, which is generally indicated when 3 or more coronary arteries
have occlusion.

It is important to note that although MICAB procedure has many advantages over
conventional open heart CABG, not everyone is a candidate for MICAB. Whether a
patient will benefit more from MICAB or Open heart surgery can be decided after the
cardiac surgeon reviews the medical details of the patient.

Indicure is the leading healthcare services company in India providing heart surgery in
India with the most established cardiac surgeons at best heart hospital at low cost. The
patients come from US, UK, Australia, Canada, New Zealand, Zimbabwe, Kenya,
Tanzania, Nigeria and many other countries for quality and affordable heart surgery in
India. For more information, log onto http://www.indicure.com/treatments/cardiac-
procedure/cardiac-surgery/open-heart-bypass-surgery-cabg.htm and
http://indicure.com/treatments/cardiac-procedure/cardiac-surgery/minimally-invasive-
heart-bypass-surgery.htm