Hearing the term coronary artery bypass surgery often conjures up images of a major operation with a long incision in the center of the chest and a lengthy recovery process. However, advances in cardiac surgery technology now allow for minimally invasive bypass procedures in suitable patients. One such approach is MICS OPCAB (Minimally Invasive Cardiac Surgery – Off-Pump Coronary Artery Bypass) , a coronary artery bypass surgery technique that uses smaller incisions and eliminates the use of a heart-lung machine.
What is Coronary Bypass Surgery?
Coronary Artery Bypass Graft (CABG) surgery is a procedure to create a new path for blood flow to the heart muscle when the coronary blood vessels are narrowed or blocked.
In coronary heart disease, blood and oxygen flow to a specific area of the heart muscle is reduced. In a bypass procedure, doctors use specific blood vessels from other parts of the patient's body to create an "alternate route" around the blocked coronary artery. This improves blood flow to the heart muscle.
What is MICS OPCAB?
MICS OPCAB is a minimally invasive approach to heart bypass surgery. MICS stands for Minimally Invasive Cardiac Surgery , while OPCAB stands for Off-Pump Coronary Artery Bypass , which is a bypass surgery performed without the use of a heart-lung machine .
Unlike conventional bypass techniques which generally use an incision in the middle of the chest and require the sternum to be opened with a special saw, MICS OPCAB is performed through a smaller incision in the patient's front left chest area.
In OPCAB, the heart continues to beat during the bypass procedure. Doctors use special stabilization devices to help keep the coronary artery area being treated stable.
How is the OPCAB MICS Procedure Performed?
In general, the procedure is carried out in several stages:
- The patient was given general anesthesia.
- Doctors make access through minimal incisions compared to conventional bypass surgery.
- The blood vessels to be used as grafts are prepared.
- The doctor accesses the coronary blood vessels that are narrowed or blocked.
- With the help of a stabilization device, the doctor creates a new blood vessel connection to bypass the blocked area.
- Once the entire bypass is complete and blood flow is assessed as good, the surgical wound is closed.
The technique and number of bypasses that can be performed will depend on the condition of the coronary arteries and the condition of each patient.
What are the advantages of MICS OPCAB?
In patients who meet the criteria, this approach may provide several benefits, including:
- The incision is much smaller than conventional bypass surgery.
- The trauma to the patient's body is lighter.
- No heart-lung machine is used in the OPCAB approach.
- Post-operative pain is less severe.
- Faster recovery.
- Surgical scars are more cosmetic.
However, MICS OPCAB is not a "risk-free operation" and is not always an option for all patients. The doctor will review several aspects, particularly lung condition, and other health conditions should be taken into consideration.
Can All Coronary Heart Disease Patients Undergo MICS OPCAB?
The doctor will conduct a thorough evaluation, especially coronary angiography, heart function and other medical history.
From the results of this evaluation, the medical team will determine whether the patient is more suitable to undergo MICS OPCAB, conventional bypass, coronary intervention such as PCI/stent, or other therapies .
Don't Be Afraid to Consult About Surgical Options
Advances in cardiac surgical techniques have provided more options for patients with coronary heart disease. MICS OPCAB is a modern approach that combines the principles of bypass surgery with minimally invasive techniques without a heart-lung machine.
However, the main goal of treatment is not just to use the technique with the smallest incision, but to choose the safest method and provide the best results according to the patient's condition .
If you or your family are diagnosed with multiple coronary artery blockages and require more than two stents or are being considered for coronary bypass, consult a Thoracic, Cardiac, and Vascular Surgeon (BTKV) to determine the most optimal long-term therapy options, including whether MICS OPCAB may be an option for your condition.
Article written by Dr. Muhammad Satyagraha Pradipto, Sp.BTKV (Thoracic, Cardiac and Vascular Surgery Specialist, EMC Alam Sutera Hospital) & Dr. Budi Gunawan, Sp.BTKV, Subsp.JD(K), FIHA, MH (Thoracic, Cardiac and Vascular Surgeon Specialist, Adult Cardiac Surgery Subspecialist (Consultant) EMC Alam Sutera Hospital).