Desun Update : November 2017 - SMALL-CUT BYPASS At Desun is a new milestone in Cardiac Surgery
CABG or Coronary Bypass Surgery in India is conventionally performed by splitting or cutting through the breastbone or sternum. But MICAS or MICS CABG surgery is considered to be a safe and complete operation and has revolutionised the way Coronary Surgery is performed.
MICS CABG or MICAS stands for Minimally Invasive Coronary Artery Bypass Surgery and is a newer form of Heart Bypass Surgery in India. It is a relatively new and advanced technique of performing Coronary Bypass for the treatment of Coronary Heart diseases.
How does it differ from conventional CABG?
Conventional CABG or Coronary Artery Bypass requires the breast bone or sternum to be cut into half. Recovery from conventional Bypass Surgery requires upto 8 weeks as the bone needs to heal. In MICS CABG, the operation is performed through the side of the chest wall. No bones are cut and healing is rapid. Healing is usually complete in 10 days.
What is the technique adapted in this Minimally Invasive Coronary Artery Bypass Surgery (CABG)?
In this technique, the heart is approached through the side of the left chest via a small 4 cm incision. This cut is placed just under the nipple. The chest is entered between the ribs without cutting any bones and by splitting the muscle.
Muscles in the area will be pushed apart. A small part of the front of the rib, called the costal cartilage, will be removed.
The surgeon will then find and prepare an artery on your chest wall (internal mammary artery) to attach to the coronary artery that is blocked.
Next, the surgeon will use sutures to connect the prepared chest artery to the blocked coronary artery.
Patient will not be on a heart-lung machine for this surgery. However, it is done under GA. A device will be attached to the heart to stabilize it & at the same time the patient will also receive medicine to slow the heart down.
The patient may have a tube in his/her chest for drainage of fluid. This will be removed in a day or two.
Among different types of CABG surgeries in India, Minimally Invasive Cardiac Surgery has several advantages over the traditional technique.
Shorter hospital stays & faster returning to Normal life:
Stays after minimally invasive operations are from 3 to 5 days compared to 5 to 7 days for traditional sternotomy-based cardiac operations. First and foremost, the fact is that no bones are cut. This has several advantages in reducing pain, retaining function and having a positive effect on breathing. Unlike a traditional heart surgery, return to normal life including driving or other activities is not disrupted and can be started almost immediately.
Less Blood Loss:
Blood loss is almost negligible eliminating blood transfusion in most and eliminating blood borne infection.
Less Chances of Infections:
All infections are reduced, whether it be wound infections or post-surgical lung infection. This makes the procedure ideal in diabetic and older patients who have poor resistance to infection.
Smaller Scars & Smaller Incisions: Minimally invasive incisions measure about 2 to 3 inches compared to 8 to 10 sternotomy incisions. The incision is so cosmetic and measures upto just 2 - 3 inches, that it's practically impossible to tell that a heart operation has been done.
Shorter hospital stays: Stays after minimally invasive operations are from 3 to 5 days compared to 5 to 7 days for traditional sternotomy- based cardiac operations.
Fewer physical restrictions: Patients undergoing standard incision cardiac operations are restricted from driving an automobile or lifting objects weighing more than 5 pounds while patients undergoing minimally invasive cardiac surgery are not subject to these restrictions.
Good To Great
All these benefits put together make for very short hospitalization and recovery. The best part is that all the blocks irrespective of their location in the heart can be bypassed in a safe and predictable manner.
Standard Sternotomy Incision This 8 to 10 inch incision splits the entire breastbone.
Mini-Sternotomy Incision This 4 to 5 inch incision just splits the upper third of the breastbone.
Mini-Thoracotomy Incision This 3 to 4 inch incision is made between the ribs whereby no bone is cut.
Port-access Incision Robotic instruments are passed through several 1/2 inch incisions between the ribs.
Will MICS CABG help to leave the hospital early and get back to work?
Definitely yes! This is exactly the reason to do this operation. Hospital stay is as short as 5 to 6 days and most patients get back to work or normal in 10 days.
Is it a beating heart operation?
Yes, it is an off pump or beating heart operation. The support of a pump may rarely be required but the operation is still performed on the beating heart. Pump support may particularly be used when the heart is weak.
Are MICS CABG and MIDCAB one and the same?
No, they are not the same. MIDCAB is an old technique where only one or two vessels can be grafted. It is often confused with the modern MICS CABG if one is unaware about recent developments.
For a diabetic patient, is MICS CABG appropriate?
Absolutely. Diabetic patient may be the ideal candidate for MICS as infection rates are almost zero. The quality of the vessels will dictate whether the patient is suitable for this technique and finally the surgeon is the best judge.
What is the risk of infections after MICS CABG?
The risk of infection is close to zero. All infections are reduced dramatically in MICS CABG even in diabetics.
If a patient is a smoker/asthmatic, is MICS CABG still an option for them?
Yes. It could be the ideal option for them. It's best for the surgeon to take that decision along with the respiratory therapist.
Are all patients with multivessel blocks candidates for MICS CABG?
No, not all patients with multivessel coronary blocks are candidates. Those with extensive disease or very poor heart function are not suitable for this technique. Heart surgeon is the best person to decide whether a candidate is suitable or not for this kind of a operation.
Is MICS CABG performed in all centres?
No, not all heart surgeons are trained in MICS. There are only a handful of centres all over the world that are capable of performing MICS safely including ours.
The New Feather in the Cap : Desun’s Paediatric Heart Surgery
Our expertise team of paediatric heart surgeons is dedicated to repairing heart defects in infants, children and adolescents. It is what we do best, and we do a lot of it. Our State-of-the-art Steel Operating Theatres are one of the best in Kolkata for minimizing the post op infections & continuous improvement of clinical outcome along with the expertise team of Anaesthesist.
Different Governments who are having official tie up with us, they rely on us for performing all complex & congenital Paediatric Heart Surgeries.
Different Paediatric Heart Surgeries Offered by Desun:
- Ventricular Septal Defect (VSD)
- Tetralogy of fallot
- Atrial Septal Defect (ASD)
- Valvular Heart Defects
- Pentalogy of fallot