A variant of the minimally invasive direct coronary artery bypass (MIDCAB) is the use of robotic visualization techniques. This strategy involves a voice-activated robot at the operating table and a cardiac surgeon one room away. The hand motions of the surgeon are processed and digitized from the controls to a computer. The computer, in turn, directs the robot where to cut and sew inside the chest. The surgeon directing the operation can view the procedure via an endoscope (a slim optical tube with an attached camera that is positioned inside the chest cavity).

The advantage of using a robot is that the “hands” are smaller than human hands and require a much smaller incision. These techniques are reported to be safe and reliable, causing less pain to the patient, less surgical trauma and a shortened recovery time. Tele-robotic heart surgery is still in the embryonic stage and is only available in limited centers worldwide.

Other minimally invasive methods of coronary artery bypass are continually being explored. A recent study reported the success of the first non-surgical bypass operation in Germany. Named percutaneous in situ coronary venous arterialization (PICVA), the procedure basically redirects blood flow around a blocked artery by diverting it to an adjacent vein. An ultrasound catheter system guides a needle into the blocked artery and through the artery wall into a nearby vein. This creates a channel into the vein, redirecting the flow of blood around the blockage. The procedure had been performed in 1999 on a patient with severe chest pain and coronary artery disease who was not a candidate for traditional bypass surgery or balloon angioplasty. A year after the procedure, the patient was still free of heart-related chest pain. Further studies are needed to determine the safety and long-term effectiveness of this procedure.