How to Explore Alternatives to Coronary Bypass Surgery

Alternatives to coronary artery bypass surgery (CABG) include procedures such as MIDCAB (minimally invasive direct coronary artery bypass), OPCAB (off-pump coronary artery bypass) and RACAB (robotic assisted coronary artery bypass), which are less invasive than the conventional coronary bypass surgery. Many of the risks associated with the conventional open heart CABG are much lower with minimally invasive heart surgery.

Difficulty: Moderately Challenging

Instructions

Understand Alternative Procedures

1. Consider the option of MIDCAB when the blockage is in the arteries located on the left anterior descending (LAD) artery. This artery and its branches are located on the front of the heart. It is not necessary to split the breastbone with MIDCAB. This procedure can only be used when there are no more than two bypasses required.

2. Explore the option of OPCAB over conventional CABG. The major difference with OPCAB is the heart-lung machine is not used. The chest is still cut open and the heart exposed to do the surgery. A vein or an artery will be taken (usually from the leg) to create the bypass.

3. Find RACAB to be the latest in cardiac surgery technology. This robot-assisted surgery is performed by the surgeon while watching a video screen. The incision is small and the breastbone is not split open.

4. Explore the possibility of using an endoscope to harvest the saphenous vein from the leg for use as bypass grafts. This method is a less invasive way than conventional coronary surgery to provide the graft for the bypass.

5. Realize changes in proactive treatment for coronary artery disease is known as therapeutic angiogenesis. This is the process of causing the body to produce its own new blood vessels (collaterals) through the process of angiogenesis. Adequate collateral blood flow will reduce the need for bypass surgery.

6. Recognize the benefits of alternatives to coronary bypass surgery. Minimally invasive procedures produce a smaller incision and scar. Other potential benefits include less bleeding, pain and trauma. Hospital stays are typically shorter, and the recovery time is less for some of the alternatives to CABG.

Tips & Warnings

• If your surgeon doesn't mention the option of alternative treatments to explore, you may need to take the initiative in asking him if your diagnosis will qualify for one of the minimally invasive techniques.
• It may be necessary to convert to conventional CABG (coronary artery bypass graft) during any of the alternative options. This may be necessary to provide adequate blood flow to the brain.
• Consider only doctors who are experienced in alternative methods.

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