MIDCAB (minimally invasive direct coronary artery bypass) surgery was developed as a less-invasive alternative to conventional coronary artery bypass graft (CABG). During a conventional CABG, the surgeon “cracks” the patient’s chest by making an incision through the breastbone and spreading the ribs. This gives the surgeon excellent access to the heart, but it results in a long recovery for the patient. Also, the incision is more prone to infection and other complications.

MIDCAB addresses these concerns by using a smaller incision in the side of the chest. Working through this smaller incision, the surgeon is able to sew bypass grafts onto diseased coronary arteries. This technique reestablishes blood flow to the heart with much less trauma to the patient and a reduced risk of infection at the site of the surgical wound. On average, patients who undergo MIDCAB may be released from the hospital within 3 to 7 days and can often return to normal activities within two weeks. By contrast, patients undergoing CABG often spend two weeks in the hospital and several months in recovery.

MIDCAB surgery may be performed with or without use of the heart-lung machine. If it is performed with the heart–lung machine, the surgeon stops the heart through use of cardioplegia solution, then uses a special system of clamps and shunts to redirect blood flow around the heart. This may be called port access surgery, after the device that is used to reroute blood flow. This technique gives the surgeon the ability to work on a still, empty heart, which increases the level of control over the operation.

If the surgery is performed without the heart-lung machine, the surgeon uses a special system of clamps and stabilizers to hold the heart still while the bypass grafts are sewn into place.

MIDCAB is used to treat the symptoms of coronary artery disease, including angina (chest pain and pressure). By reestablishing blood flow to the heart, the risk of heart attack is also reduced. Compared to conventional CABG, MIDCAB has a number of advantages and disadvantages. It offers the following advantages:

There are also some limitations to the MIDCAB:

Efforts have been made to address MIDCAB’s main limitation, which is its limited usefulness in patients with multiple vessel disease. In some cases, it has been used successfully in conjunction with a catheter-based procedure such as balloon angioplasty. In this case, disease of the LAD will be corrected with a MIDCAB graft, while blockages in other arteries may be treated with balloon angioplasty and stenting. Results for these hybrid procedures are comparable to classic CABG for multi-vessel disease.

Not all surgeons are qualified to perform minimally invasive techniques, which require greater skill and experience. Patients interested in determining their eligibility for these techniques and/or finding a qualified surgeon to perform the surgery may wish to seek a second opinion.