Mini Bypass or a ‘Multi-vessel MIDCAB’
Once the access is achieved the “left Internal Mammary Artery” (LIMA) is dissected out keeping its upper origin intact, so that blood can flow through it to the coronary artery on the surface of the heart.
It is then joined (beyond the blockage) to that particular target coronary artery. In a “Multi-vessel MIDCAB” surgery, usually an artery from fore arm called ‘Radial Artery’ is dissected out and made to join to the LIMA in an inverted Y fashion, so now we can get two arterial channels ready to deliver oxygenated blood to multiple target Coronary Arteries. The final picture is evident in a post operative angiography (see picture 2).
As it is a Beating heart surgery; and the incision is only about 4 or 5 inches, the post operative recovery is dramatically rapid and patients usually go home 4 days after operation. It is evident if you look at the picture just 12 hours after a MIDCAB surgery (see picture 3).
In recent years the so called “Mini Bypass Surgery” is gaining considerable popularity. Its scientific name is “Mult-ivessel MIDCAB”. The word “MIDCAB” is an abbreviation for ‘Minimally Invasive Direct Coronary Artery Bypass’. In this operation the breast bone, called ‘Sternum’, which occupies the front of the chest wall, is not cut through. Instead access to the heart is achieved via a small 4 or 5 inches cut under the left breast and in between two ribs, usually 4th and 5th ribs. A special arch like retractor device is used to lift the upper end of the wound to give adequate access (see picture 1).
Moreover, as the MIDCAB incision is made along the natural skin crease under the left breast, the Cosmetic effect is excellent and the scar is hardly noticeable after 6 months (see picture 4).
The first MIDCAB surgery was done by Dr. Raychaudhury was way back in February 1996. Since then in last 20 years, over One Thousand patients undergone this interesting least invasive surgery with minimum post operative pain. The long term results, even after 15 to 20 years, are extremely satisfactory
Without any cut in the leg..
Now one can have upto six or seven blockages cleared without having a cut in the leg or forearm.
We use Two arteries from inside the chest wall to bypass upto 4 blockages. These arteries last for 25 years. Then use Endoscopy to harvest the veins from the thigh without any long incision and perform 2 or 3 more additional bypass graftings if required.
Thus, a patient will have an single 8 inch vertical scar in his chest. That's all..
The second picture shows a harvested vein from left thigh without any scar, and the 1st pic shows two button hole wounds, one at groin and another below the knee joint.
Such bypasses are done on a Beating heart and the recovery is rapid. Patients are usually up and about after 48 hours..