Understanding CABG and the Advantages of Keyhole Heart Surgery

Introduction to CABG

Coronary Artery Bypass Grafting (CABG) is a surgical procedure that has saved countless lives by restoring blood flow to the heart. Traditionally, CABG involves a large incision through the chest to access the heart. This remains a very good operation. However, in recent years, advancements in medical technology have led to the emergence of minimally invasive approaches, such as keyhole heart surgery. This article will explore CABG, its various treatment options, and when keyhole heart surgery is a beneficial alternative.

Understanding Coronary Artery Bypass Grafting (CABG)

CABG, often referred to as “bypass surgery,” is a procedure performed to treat coronary artery disease (CAD). CAD occurs when the coronary arteries, which supply oxygen-rich blood to the heart muscle, become narrow or blocked due to the buildup of plaque. This can lead to chest pain (angina) or even heart attacks.

The primary goal of CABG is to improve blood flow to the heart by bypassing the blocked or narrowed coronary arteries. This is achieved by grafting a healthy blood vessel, typically from the patient’s forearm, leg or chest, to bypass the blocked or narrowed artery, creating a new pathway for blood flow to the heart muscle.

Traditional CABG Surgery

Traditional CABG surgery, also known as open-heart surgery, involves making a long incision in the chest and dividing the breastbone (sternotomy). The patient is usually placed on a heart-lung machine, which temporarily takes over the function of the heart and lungs. This allows the surgeon to temporarily stop the heart while performing the grafting procedure.

While traditional CABG has been highly effective and remains a crucial option, it comes with certain drawbacks, including:

1. Large Incision: The long incision can lead to more post-operative pain and increased scarring. and a longer recovery period.
2. Longer Recovery: The breastbone typically requires 12 weeks to fully heal. Failure to allow this to occur can risk failure
   of proper bone union which is then very difficult to correct.
3. Higher Risk of Serious Infection: Any infection affecting the sternotomy cut has a risk of also creating a bony infection which can be serious.

Minimally Invasive CABG (Keyhole Surgery)

Minimally invasive CABG, often referred to as keyhole surgery or minimally invasive direct coronary artery bypass (MIDCAB), is an alternative to traditional CABG. This approach offers several advantages:

1. Smaller Incisions: Keyhole surgery involves making smaller incisions, usually between the ribs, to access the heart. This results in less scarring and reduces post-operative pain.
2. Shorter Hospital Stay: Patients undergoing keyhole surgery often experience a shorter hospital stay, typically 2-3 days.
3. Faster Recovery: The smaller incisions and reduced trauma to the chest allow for a quicker recovery and a faster return to normal activities. Keyhole incisions typically heal in 7-10 days compared to 12 weeks after breastbone cut.
4. Reduced Risk of Serious Infection: The absence of bone division means that any infection of a keyhole incision is unlikely to produce local bony infection.
5. Less Blood Loss: Keyhole surgery can result in less blood loss during the procedure.

Is Keyhole Surgery the Best Option for Everyone?

While keyhole surgery offers significant advantages, it may not be the best option for every patient. The choice between traditional CABG and keyhole surgery depends on various factors, including the patient’s overall health, the complexity of coronary artery disease, and the surgeon’s expertise.

Keyhole coronary bypass surgery is particularly suitable for patients who have a low body fat index and are otherwise healthy. Whilst most surgeons who perform keyhole coronary bypass surgery will only graft 1 blood vessel on the front of the heart (the LAD vessel), some surgeons in the world like our lead surgeon, Mr Inderpaul Birdi, can graft 2, 3 and even 4 arteries in one procedure if certain clinical criteria are met. This procedure known as TCRAT (Total Coroary Revascularisation by Anterior Thoracotomy) requires great skill.

Conclusion on CABG

Coronary Artery Bypass Grafting is a lifesaving procedure for individuals with coronary artery disease. While traditional CABG remains a reliable and effective treatment option, keyhole heart surgery offers several advantages, including smaller incisions, shorter hospital stays, and faster recovery times. 

The choice between the two approaches should be made in consultation with a suitably skilled healthcare professional who can assess individual patient needs and determine the most suitable surgical option. Advances in medical technology continue to expand treatment choices, providing patients with options that can improve both their health and quality of life.