Minimally invasive direct coronary artery bypass surgery
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Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is a less invasive method of coronary artery bypass surgery. MIDCAB may also be referred to as "keyhole" heart surgery.
As with off-pump coronary artery bypass (OPCAB), MIDCAB is performed "off-pump" - without the use of cardiopulmonary bypass (the heart-lung machine). MIDCAB differs from OPCAB in the type of incision used for the surgery; The surgeon uses a standard median sternotomy to perform OPCAB, whereas with MIDCAB the surgeon enters the chest cavity through a small, 2-to-3 inch incision between the ribs (mini-thoracotomy) on the patient's left side.
The MIDCAB approach is most often used when one or two vessels need to be bypassed, typically on the front (anterior) side of the heart, such as the Left Anterior Descending (LAD) coronary artery. Patients requiring more that one or two grafts are usually not candidates for MIDCAB because of limited access to vessels on the back side of the heart. In most cases, the left internal thoracic artery (LITA) is used as the bypass conduit.
The technique can also be utilized for grafting the right internal mammary to the right coronary artery, and the right gastroepiploic artery to the right posterior descending artery. For better access a hemi-sternotomy may be used.
