Minimally Invasive Heart Surgery

Minimally Invasive Cardiac Surgery, also known as MICS CABG (Minimally Invasive Cardiac Surgery/Coronary Artery Bypass Grafting) or The McGinn Technique is heart surgery performed through several small incisions instead of the traditional open-heart surgery that requires a median sternotomy approach. MICS CABG is a beating-heart multi-vessel procedure performed under direct vision through an anterolateral mini-thoracotomy.

Advantages of Minimally Invasive Heart Surgery are less blood loss, reduced post-operative discomfort, faster healing times and lowered risk of infections, as well as eliminating the possibility for deep sternal wound infection or sternal non-union. This procedure makes heart surgery possible for patients who were previously considered too high risk for traditional surgery due to age or medical history. Patients referred for this procedure may have Coronary Artery Disease (CAD); aortic, mitral or tricuspid valve diseases; or previous unsuccessful stenting.

MICS CABG is performed through one 5–7 cm incision in the 4th intercostal space (ICS). In some cases the thoractomy may be necessary in the 5th ICS instead. A soft tissue refractor is used to allow for greater visibility and access. MICS CABG may be completed in an "anaortic" or no-touch off-pump technique, which has demonstrated reduced postoperative stroke and mortality compared to tradational CABG.

Two access incisions are also made at the 6th intercostal space and xphoid process to allow for instruments to position and stabilize the heart.

The McGinn Proximal Technique is performed with the blood pressure lowered to 90-100 systolic which reduces stress to the aorta. A series of tools are used to position and stabilize vessels. The technique uses devices to support the surrounding heart tissues while vital surgery takes place. This is also known as Off-Pump CABG (OPCAB). OPCAB voids the use of Cardiopulmonary Bypass (CPB), which requires the heart to be stopped (arrested) with cardioplegia solution. Off-pump is also known as beating heart surgery.

Minimally invasive heart surgery has been used as an alternative to traditional surgery for the following procedures:

A cannula with a pump and vacuum action is fed up through an artery in the groin to reduce the stress on the heart so that it may still function during the operation. This pump flows at 2-3L per minute to support circulation and eliminates the need for cardioplegia to arrest the heart.

Hybrid coronary revascularization is a common procedure that takes advantage of coronary stenting in combination with CABG. Hybrid coronary bypass is a relatively new procedure and alternative to traditional bypass surgery that is defined by the performance of coronary bypass surgery and coronary stenting of different areas of a patient’s heart. MICS CABG allows utilization of the left internal mammary artery (IMA; aka Left internal thoracic artery, Left ITA) to bypass the left anterior descending artery (LAD), which is termed as Left IMA-LAD, as a preferable anastamosis whenever indicated and technically feasible (Loop et al.) and has been proven to benefit in event free survival (Acinapura et al.). The other one or two arteries will be stented, when appropriate, allowing cardiologists and cardiothoracic surgeons to work together.

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