1 March 2019 How is a coronary bypass carried out? Coronary bypass is a surgical procedure for the revascularisation of the myocardium (heart muscle), which can be performed in the following ways: Open surgery: an incision of approximately 15 cm is made along the middle line of the thorax, which includes the sternum (sternotomy); Robotic surgery: small incisions are made so that the instruments coupled to the robotic arms of the system can reach the heart. What are the details of the robotic coronary bypass? There are various approaches to coronary revascularisation surgery with robotic support, depending on the experience and surgical background of the team carrying out the procedure. With the technique known as Assisted Minimally Invasive Direct Coronary Artery bypass (MIDCAB), the robot is used to: Prepare the internal thoracic artery; Pericardiectomy; Investigate; Prepare the vessel where the anastomosis (bypass) is to be carried out. The process involves making three small incisions of around 1 cm each to enable access by the robotic arms to the left chest cavity. The bypass is carried out with direct visualisation of the heart, through a left minithorachotomy measuring 7 to 10 cm long and with the heart beating. In this way, not only is the need for a sternotomy avoided, but also the need for extracorporeal circulation. Compared to open heart surgery, robotic heart bypass has the following advantages: Avoids the need for sternotomy: patients who undergo sternotomy (open heart surgery) have to wait on average 4 to 6 weeks after the operation before they can drive again. In addition, in many cases, some symptoms associated with sternotomy, such as chest, joint and muscle pain, can take 2 to 3 months to disappear; Smaller incision: as with all surgical procedures, this is associated with fewer problems related to the surgical wound; in particular, dehiscence (reopening of the wound) or infection; Less pain in the medium to long term; Reduced need for transfusion; Less risk of local or generalised infection; Shorter time in hospital; Faster return to daily activities; Less visible operating scars. The robot-assisted Minimally Invasive Direct Coronary Artery bypass (MIDCAB) technique uses robotic support at various stages to minimise aggression and surgical trauma. Upon whom can the robotic coronary bypass performed? Patients with only anterior descending artery disease; Patients with disease involving two or more vessels but where the minimally invasive approach is considered to be of added value due to the minimisation of risk; Patients with disease affecting two or more vessels who are suitable for hybrid therapy: i.e. surgical treatment for coronary revascularisation of the anterior descendant artery. This will have to be supplemented with a cardiological approach to treat lesions in the remaining vessels with the placement of stents. This article was written with the support of physicians and other clinical professionals from the Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
