Minimally Invasive Surgery , also known as MICS CABG (Minimally Invasive Bypass Bypass or Coronary Grafting Bypass) or McGinn's Technique is a cardiac surgery performed through some small incisions rather than traditional open heart surgery requiring a median sternotomy approach. MICS CABG is a cardiac multi-vascular procedure that is performed under direct vision through an anterolateral mini thoracotomy.
Advantages of minimally Invasive Cardiac Surgery are reduced blood loss, reduced post-operative discomfort, faster healing time and lower risk of infection, and eliminates the possibility of sternal or sternal non-union wound infection. This procedure makes heart surgery possible for patients previously thought to be at 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 disease; or stenting that did not work before.
Video Minimally invasive cardiac surgery
Prosedur
MICS CABG is performed through a 5-7 cm incision in the IV intercostal space (ICS). In some cases, thoractomy may be required in the 5th ICS. A soft tissue refractor is used to allow greater visibility and access. MICS CABG can be completed by "anaortic" or non-touch off-pump technique, which has shown a decrease in postoperative stroke and death compared to CABG tradational.
Two access incisions are also made in the 6th intercostal space and the xphoid process to allow the instrument to position and stabilize the heart.
Maps Minimally invasive cardiac surgery
McGinn's Technique (Proximal Anastomosis)
The McGinn Proximal technique is performed with blood pressure lowered to 90-100 systolic which reduces stress in the aorta. A series of tools are used to position and stabilize the ship. This technique uses the device to support the surrounding heart tissue while important surgery takes place. This is also known as Off-Pump CABG (OPCAB). OPCAB cancels the use of Cardiopulmonary Bypass (CPB), which requires the heart to stop (arrested) with a 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:
- Coronary artery shortcuts
- Mitral valve repair
- Mitral valve replacement
- Aortic valve replacement
- Atrial septal defect
- Hybrid coronary revascularization
Beating heart bypass with the help of pump
A cannula with a pump and vacuum action is inserted through an artery in the crotch to reduce stress on the heart so it can still function during surgery. These pumps flow at 2-3L per minute to support circulation and eliminate the need for cardioplegia to capture the heart.
Revascularization of hybrid coronary
Hybrid coronary revascularization is a common procedure that takes advantage of coronary stenting in combination with CABG. Hybrid coronary bypass is a relatively new and alternative procedure for traditional bypass surgery defined by coronary bypass surgery performance and coronary stenting of different areas of the patient's liver. MICS CABG allows the utilization of the left internal mamaria artery (IMA, alias left internal thoracic artery, Left ITA) to bypass the left anterior descending artery (LAD), referred to as Left IMA-LAD, as a better anastamosis whenever indicated and technically feasible (Loop et al.) And has proven to be beneficial in the survival of free events (Acinapura et al.). One or two other arteries will be stent, if necessary, allow cardiologists and cardiothoracic surgeons to work together.
After operation
After minimally invasive procedures, the patient recovers faster than from a sternotomy and experiences fewer complications. Most patients can expect to continue their daily activities within a few weeks after their surgery. After surgery, the patient is given an anesthetic pain pump and a drainage that will be removed before disposal. Patients are encouraged to move as much as possible after their surgery recovers quickly. After discharge from the hospital, the patient does not need further postoperative assistance.
Minimally invasive heart surgery is a safe and wide-ranging technique for performing complex cardiac procedures, including single or double heart valve procedures, bypass surgery, and congenital heart repair.
Benefits of MICS CABG/McGinn Techniques
Eliminating the need for median sternotomy greatly reduces the trauma and pain associated with open chest surgery and improves the patient's quality of life. At the hospital, reducing post-operative discomfort allows the patient to immediately begin a shorter recovery process. Most patients are more easily ambient and participate more actively in their personal care. In addition, this approach lowers the risk of complications such as bleeding, infection and eliminating the risk of sternal nonion.
Minimally invasive heart surgery improves cosmetic results. Instead of a prominent 10-inch scar in the center of the chest, the patient is left with a small sign to the side of the rib cage. For women, in many cases, this scar is completely invisible because it is under the breast.
Benefits Include:
- No division of breastbone
- Reduce pain
- Lower infection risk
- Lower the risk of bleeding
- Reduce ICU and hospital room
- Improved postoperative lung function
- Recovery acceleration/return to activity
- Improved quality of life
- Greatly improves cosmetic results
CABG MICS Study Results
2014
At the 2014 International Society for Annual Meeting of Minimum Cardiovascular Surgery in Boston, Dr. Joseph T McGinn presented a study entitled "Invasive Minimally Safe and Productive CABG: Report on the First Thousand Cases," which found low conversion rates to sternotomy and low complication rates. Assessing survival and adverse cardiac event up to 8.0 years (mean 2.9 Â ± 2.0 years), MICS CABG is a safe and reproducible operation that results in survival (96.1 Â ± 0, 9%) and durability comparable to conventional CABG.
2013
The Journal of Thoracic and Cardiovascular Surgery published a study on 1 November 2013 confirming that CABG MICS is safe, viable, and associated with excellent graft levels at 6 months postoperatively, with 92% graft patency for all graft and 100% for leaving the internal thoracic artery graft. Coronary artery cut graft patency is studied through computed tomography angiography. 92% of patients are free of angina and no participants have aortic complications, recurrent revascularization, cerebrovascular accident, myocardial infarction or death. This two year study involved 91 participants between the ages of 48 and 79, the average stay in the hospital for 4 days (range, 3-9 days). Registration Clinical Trial Unique identifier: NCT01334866. [9]
2012
At the 2012 American Heart Association Scientific Session and the Resuscitation Science Symposium, a study entitled "Minimally Invasive CABG: Results Up to 6 Years" is presented, demonstrating the feasibility of MICS CABG and alternatives set for the CABG multivessel sternotomy. It was also noted that this procedure was associated with short duration of hospital stay, no wound infection and safe infection. This study also proves the survival and endurance equivalent of a sternotomy.
2010
At the 2010 International Society for the Annual Meeting of Minimally Invasive Cardiovascular Surgery in Berlin, Germany, data center duel presented standardization of MICS CABG in the performance and reproducibility of its results. The safety and effective alternatives for surgical revascularization of myocardial heartbeat (OPCAB) are emphasized. "Shortening hospital stay is beginning to be realized and its application to high-risk and complex patients is now underway."
2009
The 2009 Publication in Circulation, entitled "Minimally Invasive Small Gradient Spread Grafting: Dual-Center Experience in 450 Responsible Patients" concluded the CABG MICS as a viable procedure with excellent short-term outcomes. At the time, the study noted, "this operation has the potential to make MICS CABG multivessel safe, effective and more widely available."
History
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