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The Benefits of the newer techniques in CABG as opposed to conventional CABG

Shorter length of stay:
Patients may experience less pain and may have a better ability to cough and breathe deeply after the operation so they are often discharged from the hospital in 2 to 3 days earllier, compared to conventional CABG surgery.

Faster recovery:
Avoidance of the heart-lung machine reduce the risks of complications such as stroke and renal failure so that patients can return to their normal activities in 2 weeks rather than the typical 6 to 8 weeks with conventional surgery.

Less bleeding and blood trauma:
Any time blood is removed from the body and put into the heart-lung machine, the patient must be put on anticlotting medications or given "blood products". Artificial circuits such as the heart-lung machine can also damage blood cells. These factors may affect the blood's ability to clot after surgery. Avoiding the heart-lung machine can alleviate this blood trauma. Use of Cell Saver often eliminates the need for blood transfusion and its risks.

Lower infection rate:
Often only a relatively smaller incision on the chest means less handling of tissue, which may reduce the chances of infection. Also no long leg wounds to increase infection chances.

Available to more patients:
Some patients are poor candidates for traditional bypass surgery because their illness is too widespread, their heart is too weak, or because they will not accept blood products. These patients are able to receive this life-saving surgery through OPCAB.

The way Coronary artery disease is increasing rapidly in India is a matter of concern. It is important to spread awareness about coronary heart disease which is preventable by lifestyle modification, early detection and treatment of diabetes and hypertension. If one develops coronary artery blockage it is treatable by timely intervention. One of the best surgical interventional treatments for coronary artery disease is All Arterial Off pump Bypass surgery with no touch Aorta technique.

Beating Heart Surgery

During this procedure, the heart is not stopped (no cardioplegia) and heart lung machine is not used. The heart and lungs continue their normal function while CABG is being performed. This is also called Beating Heart Bypass surgery. With the heart still beating, the operation requires greater surgical skills and is done by select surgeons only.

There are many advantages of off pump CABG namely lower risk of strokes, faster recovery from surgery resulting in shorter ICU and hospital stay. In high risk patients with impaired kidney function, poor heart function or Redo CABG (second time) this surgical technique is better as it provides protection to the heart.

All arterial Grafts

What is very crucial for the long term success of CABG is what is being used as a graft to bypass the blocked coronary artery. Most surgeons use veins from legs for this purpose and this leads to blocked grafts within a few years. But the use of arteries from the chest and hand for bypassing the blocked coronary arteries can help avoid this. This is called All Arterial CABG.

The life of veinous grafts is around 5 years but the arterial grafts last longer than 20 years. It has been conclusively proven by studies that chest arteries (IMA) have better patency than veins and even drug coated stents. The arteries not only last longer but the blood flow in arteries increases with physical activity so after surgery patients can not only carry out normal activities and can do strenuous exercises without any problem.

The only challenge of All Arterial CABG is that it is technically more demanding and the surgeon needs to be specially trained.

CABG with No Touch Aorta technique

The possibility of avoiding the manipulation (touching) of the aorta plays a key role in protection of brain in off-pump CABG. Dr K K Saha has devised a new surgical technique to avoid direct manipulation of the aorta (main blood vessel arising from the heart). This eliminates the risk of stroke (brain paralysis) after CABG.

He has presented papers in international conferences about this new technique. He has also published papers about this new technique which helps prevent paralysis after bypass surgery.

Bypass without blood Transfusion

The cell saver machine collects the blood lost during surgery cleans it so that it can be given back to the patient. This eliminates all the risks involved with blood transfusion –HIV, Malaria, Hepatitis etc. In patients with normal haemoglobin, CABG can be performed without blood transfusion using this machine.

MICAS - Minimally Invasive Cardiac Surgery

Minimally invasive heart surgery (also called Keyhole Surgery) is performed through small incisions, sometimes using specialized surgical instruments. The incision used for minimally invasive heart surgery is much smaller about 3 to 4 inches. Minimally Invasive Cardiac Surgery (MICAS) or Minimally invasive direct coronary artery bypass graft (MIDCABG) surgery is an option for some patients. The technique for minimally invasive CABG surgery that is used by me is on a beating (off-pump) heart and commonly the left internal mammary artery bypass graft is being used.

  • The benefits of minimally invasive heart surgery techniques include:
    • Small incisions
    • Dramatic reduction in pain
    • Small scars – greatly improved cosmetic result
    • Shorter ICU and hospital stay after surgery: The average stay is 3 to 6 days after minimally invasive surgery,
    • Low risk of infection
    • Low risk of bleeding and blood transfusion
    • Shorter recovery time and faster return to normal activities/work: The average recovery time after minimally invasive surgery is 1 to 4 weeks, while the average recovery time after traditional heart surgery is 6 to 8 weeks.
    • Division of the breastbone (median sternotomy) is not needed for minimally invasive heart surgery.

Important Note: Not everyone is a candidate for these surgical techniques. Your surgeon will review the results of your diagnostic tests before your scheduled procedure to determine if you are a candidate for minimally invasive surgery. The surgical team will carefully compare the advantages and disadvantages of minimally invasive techniques versus traditional surgery techniques.