By: Dr. Ratan Kumar Das, MBBS, MS, MCh. Director Cardiac Surgery, BMBirla Heart Research centre, Kolkata 700027

We all know that bypass surgery is a big invasive surgery and  leaves behind a big scar . As an alternative  the same procedure can be done with a small cut which involves less trauma and discomfort.   Who will not like if he can has a bypass surgery with a smaller incision. We do not have a terminology like maximal invasive bypass surgery.  The normal  or traditional way of doing the bypass surgery involves a big cut  ( approximately 8 inch) in the middle of chest through the breast bone . However , Minimally invasive bypass surgery involves making a small incision ( 4 to 5 cm) in the left side of chest between the ribs.

Minimally Invasive bypass surgery is complex procedure and needs training and experience of the surgeon. Though it is not an option for everyone,  minimally  invasive procedure has  many benefits when compared with conventional bypass surgery   which includes

: Less blood loss

: Lower risk of infection as it does not involve cutting of bone

: As the trauma is less pain is lower and hospital stay is shorter

: Recovery is faster and patients can resume normal activities earlier

: There is smaller and less noticeable scar.

However there are some disadvantages we come across with this  procedure like, it requires special instruments, need trained and experienced surgeon, operative time is little longer than conventional bypass, occasionally you may need to abandon the procedure and  convert  the procedure to traditional method if we come across with problem while doing the surgery.

This procedure can be done for all three coronary arteries. Few years ago this procedure was limited only for left sided arteries. However,   more and more surgeons are bypassing the right sided vessel successfully nowadays.  Multi vessel coronary bypass can be performed with this technique in a large number of patients with an excellent procedural outcome.  We have been doing Minimally invasive multivessel  ( three vessel) bypass surgery in BMBirla Heart Research center regularly for years.

We often come across the term bypass with LIMA RIMA  in common parlance regarding its durability .  LIMA RIMA are arteries taken from inside the chest wall  and  used for bypassing the coronary arteries and usually done by conventional  technique.  In this way we can avoid making cut on legs. As this is a total arterial grafting, patient may not need a second surgery for more than 20 years.  Now the question is, can LIMA RIMA  bypass possible with minimally invasive procedure?  Yes with the invention of newer instrument it is nowadays possible to take out both the LIMA and RIMA  through the small cut in left side of the chest and surgeons are doing  LIMA RIMA bypass using minimally invasive technique  more often.

However there are some limitations of this procedure.  Not everyone is a candidate for minimally invasive bypass surgery.   Patients  who  have history of previous heart surgery,  history of chest trauma , too high risk patients, older age ,poor and big hearts should opt for the traditional bypass surgery which is still considered as gold standard procedure.

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