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Coronary Artery Bypass Surgery: Minimally Invasive Methods - Topic Overview

Standard coronary artery bypass graft (CABG) surgery works very well to improve blood flow to the heart. But the procedure is very invasive to your body for two major reasons.

  • It involves making a large cut in your chest to expose your heart and arteries.
  • It requires stopping your heart and connecting you to a heart-lung bypass machine. The machine takes over the work of your heart and lungs.

Because it is so invasive, the procedure can cause several complications. Surgeons have devised several new methods that are less invasive and have fewer risks. But minimally invasive CABG surgery is not available everywhere. And this surgery is not right for everyone.

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Beating-heart surgery

Beating-heart surgery is different from the standard CABG surgery. During a standard CABG procedure, your heart will be stopped and you will be connected to a heart-lung bypass machine. Beating-heart surgery (BHS) is unique. That's because the procedure is performed while your heart is still beating. You don't need the heart-lung bypass machine.

There are two main types of beating-heart surgery (BHS). (Both are types of minimally invasive CABG surgery.)

  • Minimally invasive direct coronary artery bypass (MIDCAB)
  • Off-pump coronary artery bypass (OPCAB)


MIDCAB surgery differs from traditional CABG surgery in two ways. First, MIDCAB does not use the heart-lung bypass machine. Second, your surgeon will cut several small incisions in your chest to access your coronary arteries. These small cuts are called thoracotomies. They are used instead of the one large incision (sternotomy) used in traditional CABG surgery. These smaller cuts expose only the sections of your arteries that require grafts. They don't expose your whole heart. This means you have a lower risk of infection. You also do not have a large scar like you would have with traditional CABG surgery.

The main disadvantage of MIDCAB is that it can't be used to treat several diseased vessels. This is especially true if arteries on both the left and right sides of the heart are affected. The limited number of small incisions made using MIDCAB makes it hard to treat more than two coronary arteries during the same surgery.

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