Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

One of the most recent innovations in heart surgery allows the surgeon to perform a coronary artery bypass graft (CABG) without opening the entire chest and stopping the heartbeat! This procedure is called Minimally Invasive Direct Coronary Artery Bypass, or MIDCAB.

The purpose of MIDCAB is the same as for a standard CABG: to create a bypass around a blockage in a heart artery, so that blood can flow to the heart muscle. Not all patients qualify for this procedure: It is suitable for those who have a blockage in the artery on the front of the heart—the left anterior descending (LAD) artery.

In the operating room, after the patient is under anesthesia, the surgeon makes an incision that's only about two inches long (as opposed to 10-12 inches for standard CABG) on the front of the chest, towards the left side. The surgeon then goes between the ribs to reach the mammary artery, which branches from the artery to the arm. Working carefully, the surgeon clips away the tiny branch arteries to prevent bleeding later on. Then the surgeon clamps off the mammary artery and frees the lower end, leaving the artery attached at its upper end.

An opening is then made in the pericardium. The next step is to stitch the free end of the mammary artery below the blockage in the left anterior descending (LAD) artery, on the surface of the heart.

The mammary artery and the LAD artery are both about the size of a piece of spaghetti. Sewing them together is difficult even when they are not moving with each heartbeat. With the heart still pumping, the procedure requires techniquest to compensate for the heart's action. A mechanical stabilizer, attached to the heart, reduces its movement (see "Without Missing a Beat!"), the surgeon connects the two arteries with hair-thin sutures. Then the clamp on the mammary artery is released, and blood can flow from the mammary artery through the LAD coronary artery, bypassing the blockage and providing oxygen-rich blood to the heart muscle.

The procedure takes about 2 1/2 hours, and the patient usually spends about one day in the Surgical Intensive Care Unit and one or two days in a regular surgical unit, being monitored and undergoing inpatient cardiac rehabilitation. Not long after being discharged, the patient can begin our Healthy Heart Program (formerly Outpatient Cardiac Rehab).