At Stony Brook University Hospital, we offer some of the most advanced treatments for coronary artery disease, including robotic-assisted coronary artery bypass graft surgery (CABG). Traditionally, CABG surgery has been an open-chest procedure, requiring a large incision, separation of the breastbone, use of the beating heart machine, and long recovery times. While traditional CABG procedures offer many benefits, Stony Brook's heart surgeons offer minimally invasive alternatives to traditional open CABG, such as beating heart surgery (OPCAB, MIDCAB) and robot-assisted CABG. Using smaller incisions and tiny surgical instruments to perform these procedures, patients enjoy the benefits of less pain and quicker recovery time with comparable outcomes.
CABG is performed to restore blood flow to your heart by bypassing coronary (heart) arteries that have been narrowed or blocked by the build-up of plaque. In CABG, a surgeon uses a piece of an artery or vein from another part of your body to reroute blood around the blocked or narrowed portion of your coronary artery or arteries.
Traditional bypass surgery required that the surgeon cut the chest open at the breastbone and spread the ribs to expose the heart. In addition, to work on the heart itself, the heart is stilled and the patient's circulatory function taken over temporarily by a heart-lung bypass machine.
Robotically assisted MIDCAB is a minimally invasive procedure in which the surgeon makes several tiny incisions between your ribs then inserts small robotic arms and a small camera through the incisions. Special tools stabilize the part of your heart on which the surgeon must work, which enables the heart to continue beating throughout the procedure.
During the surgery, your surgeon sits at a computer console. The camera provides images of the heart that are magnified up to 10 times that of a person's normal vision. From the console, the surgeon controls the robotic arms, which have greater range of motion and are much more precise than a person's unassisted movements. The surgeon uses the internal mammary artery or arteries, which are located in your chest and provide the longest-lasting and best-quality graft in this type of procedure. The surgeon harvests the mammary artery and may use the robot to move one end of the internal mammary artery and connect, or graft, it to the blocked artery at a point below the blockage, which restores blood flow to your heart.
How to Prepare
Your surgeon will perform a physical examination and review your medical history before your procedure. Be sure to bring a list of any medications, dietary supplements, or herbal supplements that you take with you to your doctor's appointment. Tell your doctor if you have any allergies to medication or have had any problems with anesthesia. Your surgeon will give you any specific instructions about dietary or activity restrictions.
You also may undergo several pre-operative imaging tests, in which the arteries that deliver blood to your heart are evaluated.
Although your surgeon will give you specific instructions, you may be instructed to stop taking some medications before the surgery. You also may be asked to not eat or drink after midnight on the night before your procedure. Your surgeon will instruct you about whether you should take your regular medications on the day of the procedure.
What to Expect
CABG procedures are performed under general anesthesia. Once you have been anesthetized, a tube will be inserted through your mouth to help you breath during the procedure. You will also be given a medication to decrease your heart rate. If robotic surgery is performed, your surgeon will sit at a computer console with a monitor, which provides a three-dimensional, enlarged view of the heart. Your surgeon will perform at least some of the procedure by controlling the robotic arms with his or her hands.
For minimally invasive (MIDCAB) procedures with the robot, the surgeon makes three small incisions in the spaces between your ribs and then inserts surgical instruments and a camera connected to the robotic arms through them. The surgeon will use tools that stabilize your heart to provide access to the blocked arteries. With one part of your heart stabilized, the rest of your heart continues pumping rich blood to your body. Alternately, CABG can be performed by dividing the breastbone and with the use of the heart lung machine (CABG) or without it.
The cardiac surgeon generally uses the patient's own internal mammary artery or arteries, which are both located inside your chest, for at least one of the bypasses. In addition, a vein from the leg or artery from the arm can be harvested through a small incision (endoscopically). Using newer surgical techniques and the robotic arms, the surgeon typically moves one end of the internal mammary artery and connects it to the blocked artery at a point below the blockage, which restores blood flow to the heart. Once the graft is secure and blood is flowing through it, the surgeon closes the incision and the procedure is complete. The procedure can take between 1 and 4 hours to complete.
Possible Complications
There is a small risk of complications from this procedure that includes (but is not limited to):
- Infection;
- Bleeding;
- Heart Failure;
- Breathing problems;
- Blood clots; and
- Stroke or brain damage.
Recovery
After surgery, you will be taken to the intensive care unit (ICU), where your recovery will be monitored. You will have a breathing tube in your mouth to help you breathe until you are awake and able to breathe on your own. You will have several intravenous (IV) lines to give you medication and fluids, and you will also have several drainage tubes in place, which will be removed as you improve and recover.
Once your condition is considered stable, you will be moved from the ICU to a regular room. You should expect to stay in the hospital for 2 to 5 days, but full recovery can take a few weeks. Before you are discharged from the hospital, you will receive specific instructions about how to care for your incision. Typically, you should keep the incision clean and dry, using only soap and water to clean the area.
For more information, see Minimally Invasive Bypass Surgery.