Coronary Artery Bypass Graft (CABG)

Off-pump coronary artery bypass (OPCAB) is a technique that avoids the heart-lung machine and is performed without stopping the heart. In this technique, a small portion of the heart is stabilized adjacent to the vessel that we have identified for bypass. A heart surgeon places a device that looks like a tuning fork against that portion of the heart and immobilizes it while the rest of the heart beats normally.

Minimally invasive direct coronary artery bypass (MIDCAB ) is a technique that spares the breast bone. Instead, the heart surgeon makes a small incision under the left breast. Then the internal mammary artery that runs on the inside of the chest wall is harvested and attached to the coronary artery on a beating heart. Heart patients having this approach tend to leave the hospital sooner and recover faster but may experience more pain in the first few days.

ThoraCAB is a technique similar to the MIDCAB that approaches the heart from the side through a lateral or posterolateral thoracotomy. This approach gives the heart doctor access to blood vessels on the lateral and posterior aspects of the heart. It is particularly useful in patients who have isolated disease of the circumflex artery in a redo situation where standard approaches would jeopardize functioning bypass grafts to other parts of the heart, such as the anterior descending artery. The vein or artery used as a conduit for the bypass is attached at one end to the descending aorta.

Robotic MIDCAB is a technique that uses a robot to harvest the left internal mammary artery using a closed-chest approach prior to using a MIDCAB incision to complete the bypass. As with the traditional MIDCAB, it is possible to achieve bypass of multiple blockages. One advantage of the robot is that it allows the harvest of both mammary arteries and requires less distraction of the rib cage.

Transmyocardial Revascularization (TMR) is a technique that uses a laser to drill channels in the heart, allowing blood from the ventricular chamber to perfuse the heart directly. This approach is used when the patient's blood vessels are too small or too diseased to allow conventional bypass surgery and is often used in conjunction with bypass surgery when diffuse disease is present. Heart patients often experience relief of angina, but it is difficult to show increased blood flow.

Hybrid surgery is an approach whereby the heart surgeon and the interventional cardiologist work together to achieve complete revascularization of the heart. A MIDCAB approach is used to revascularize the anterior descending artery, and the remaining vessels are revascularized by stenting. This is especially useful in patients who are at high risk for standard surgical approach