Minimally Invasive CABG
Surgeons at St. Luke's-Roosevelt were the first in the world to popularize the internal mammary artery for use as a bypass graft in 1968. They likewise have had the nation's longest experience with arterial bypass grafting. This great tradition of coronary artery bypass grafting has enabled our surgeons to expand their expertise into the field of minimally invasive CABG. This includes operations which both limit the incision necessary for bypass grafting as well as those that eliminate the need for the heart-lung machine.

Off Pump Coronary Artery Bypass (OpCAB)

Off pump coronary artery bypass (or OpCAB) refers to coronary artery bypass grafting without the use of the heart-lung machine. Bypass grafts are sewn to the heart while it is still beating with the aid of a special stabilizer which keeps the target still for the operation. By avoiding the heart-lung machine, patients have a reduced risk of bleeding, stroke and cognitive problems following surgery. If more than one bypass graft needs to be performed, a full sternotomy incision is necessary.

Robotically-assisted Minimally Invasive Direct Coronary Artery Bypass (midCAB)

The most important part of a CABG operation is the bypass graft of the internal mammary artery (LIMA) to the left anterior descending artery (LAD). Patients with isolated disease of the LAD may be treated with angioplasty and stenting via percutaneous approaches through the groin. Although quite successful in the hands of our world-class interventional cardiologists, this procedure is still plagued by the problem of restenosis and the need for recurrent intervention in 18-30% of patients.

With the use of the robot the internal mammary artery can be sewn to the LAD through a small incision while the heart is still beating. This minimally invasive direct coronary artery bypass (midCAB) can be performed through a partial division of the lower breastbone or through a small incision on the left chest. The LIMA-LAD anastomosis has a patency rate of 95% at 10 years and is the major factor in predicting long-term survival in patients with coronary artery disease.

We have recently expanded the application of robotically-assisted mid-CAB to selected patients with disease in several arteries. By combining stenting and robotic mid-CAB all territories may be revascularized through a minimally invasive approach.

Totally Endoscopic Coronary Artery Bypass (TECAB)

Coronary artery bypass grafting can now be performed totally endoscopically without any incisions. Selected patients with isolated disease of the LAD artery are potential candidates for this new operation. The procedure is performed on the beating heart and the robot is used to both harvest the internal mammary artery from underneath the chest and to sew it to the LAD. This operation can only be performed within the confines of an ongoing FDA trial, and St. Luke's-Roosevelt is only one of three centers in the country capable of presently performing this operation.

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