Maryland Heart Center

Minimally Invasive Coronary Bypass Surgery

Minimally Invasive Coronary Artery Bypass (MIDCAB) with Stented Angioplasty (the "Hybrid" Procedure)

Hybrid procedure recognized as a 2005 "Innovation of the Year" by the Daily Record, a Maryland business journal

Learn more about this innovative treatment that the Medical Center is among the first hospitals in the country to perform in the same operating room.

What is the hybrid procedure?

Our operating room is both a fully equipped surgical suite and a state-of-the-art cardiac catheterization laboratory in the same room.

The hybrid procedure is an innovative approach to double or triple vessel coronary artery disease. The hybrid approach combines minimally invasive coronary artery bypass surgery with stented angioplasty at the same time. Stents are small wire tubes that keep narrowed arteries open.

The hybrid procedure begins with a minimally invasive direct coronary bypass, known as MIDCAB. In contrast to open-heart bypass surgery, where the chest is cut open at the sternum to gain access to the heart, the surgeon creates a tiny, two-and-a-half inch opening between two ribs in the left side of the chest. The doctor then removes part of another artery from the chest through this keyhole-size opening and sews it to the heart to bypass the blocked artery.

With this minimally invasive surgery, the heart remains beating throughout the procedure, which is safer and poses fewer side effects than having the patient on a heart-lung machine to maintain circulation.

When the bypass surgery is complete, a cardiologist takes over with angioplasty to restore normal blood flow in arteries that are not blocked enough to require a bypass. To reduce the chance that the blockage will recur, coated stents are used. The stents are coated with a medication that prevents reblocking, also known as restenosis.

Although the procedures are not new, the fact that they are combined is. In fact, the University of Maryland Medical Center is among the first hospitals in the U.S. to do the combined procedure in the same operating room. Until now, patients needing both procedures would have bypass surgery first and then angioplasty a day or two later or the reverse.

Why combine stenting with the MIDCAB?

With MIDCAB, the left internal mammary artery (LIMA) is used to bypass the blockages in the left anterior descending artery (LAD), which provides a survival benefit in a minimally invasive way. At the same time, patients receive a more complete revascularization because the other arteries that are not addressed by bypass will be addressed with stents. So the hybrid procedure combines the best of both worlds -- bypass surgery and stenting -- by using a minimally invasive surgical procedure that has longevity and using stents for what they are best at, which is taking care of non-LAD vessels.

What are the other advantages of the hybrid procedure?

This approach benefits patients because it is more convenient and less stressful to have both bypass surgery and stenting performed at the same time, rather than on separate days.

Another advantage for patients is that this type of bypass surgery can be performed without a major incision. It's a less invasive procedure with improved chances for long-term success. Patients can also expect quicker recovery times and reduced hospital stays.

How long is the typical hospital stay?

Most patients who undergo the hybrid procedure go home in two or three days. In contrast, the average stay here after standard open heart surgery is six and a half days.

Who is a good candidate for the hybrid procedure?

Ideal candidates for the hybrid procedure have a blockage in a major vessel called the left anterior descending (LAD) artery, which supplies 60 percent of the blood to the heart, as well as blockages in non-LAD arteries that can be treated with a stent.

Why should patients come to the Maryland Heart Center?

Our operating room is both a fully equipped surgical suite and a state-of-the-art cardiac catheterization laboratory in the same room. We are one of the only hospitals in the area to have this combined OR and one of the first in the nation to perform the hybrid procedure. This combined OR presents a tremendous advantage, because if for some reason doctors are unable to get a satisfactory result from the angioplasty side, then they can convert to an open bypass operation. The patient won't have to be moved to another room because they will already be in an operating room, which is equipped with a heart-lung machine.

We have the ability to monitor platelets. A major challenge with the combined bypass/stenting procedures is to carefully monitor the status of blood platelets before, during and afterward. Platelets are part of the body's defenses against sudden blood loss. They form clots to stop bleeding, but clots during heart surgery could jeopardize patient safety by causing a stroke, and platelet clumping around a stent could impact the long-term success of the therapy. Blood clotting is an important issue with a hybrid procedure, and we use specialized tests to evaluate and monitor each patient's blood clotting properties when we do these procedures. We have four different tests that determine whether the patient is at high risk for bleeding.

We employ highly skilled radiologists with expertise in CT scan technology. These CT scans can now actually help diagnose coronary artery disease. After the surgery, our radiologists can document whether the artery remains unblocked before the patient leaves the hospital, thus ensuring that the graft is in good condition.

Research. Every patient who has a minimally invasive cardiac surgery and beating heart surgery is enrolled in a clinical trial. Doctors look at patients' coagulation before surgery, after surgery, and when they come back for clinical follow-up.

Please call if you would like to make an appointment or talk to someone about our services. Patients dial 1-800-492-5538 or 410-328-5842, physicians dial 410-328-6622 or 1-800-318-1019.