Maryland Heart Center

Minimally Invasive Coronary Bypass Surgery

Robot-Assisted Triple Bypass Heart Surgery at the University of Maryland Medical Center

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The majority of patients who require bypass surgery have more than two blocked arteries going to the heart, according to Johannes Bonatti, M.D., a cardiac surgeon recognized as one of the world’s most experienced in minimally invasive coronary operations using the da Vinci robot. Recently Dr. Bonatti – who is also a professor of surgery at the University of Maryland School of Medicine -- performed a rare triple bypass heart surgery using robotic assistance. The ability to bypass three vessels now means that many more patients can benefit from this minimally invasive, robot-assisted heart surgery, known as robot-assisted totally endoscopic coronary artery bypass (TECAB)

This procedure, which does not require any large incisions, presents a durable alternative to open heart surgery for patients with multiple blocked coronary arteries. The University of Maryland Medical Center is only the second place in the United States to have performed robot-assisted triple bypass and the first in the world to achieve the triple bypass using an advanced, minimally-invasive heart-lung machine.

What is Triple Bypass and How is it Performed?
Advantages of Minimally Invasive Surgery
Why Come to the University of Maryland?
Whom do I Contact for More Information?

What is Triple Bypass and How is it Performed?

Multiple bypasses are possible with open heart surgery, in which the chest is opened to provide full access to the heart. But the downside of open heart surgery is long recovery, increased risk of infection and other issues. Most patients prefer minimally invasive surgery, if given the option. The least invasive of current options is known as robot-assisted totally endoscopic coronary artery bypass (TECAB). Dr. Bonatti routinely performs TECAB with the da Vinci robot.

Until now, technical issues had limited robot-assisted bypass surgery to a maximum of two bypass grafts. But Dr. Bonatti and his team have been working to overcome those barriers with improved techniques and new instruments that lift the heart up from the chest to provide access to blocked vessels on the back of the heart. So now surgeons can bypass three vessels, meaning that more patients can benefit from this minimally invasive, robot-assisted heart surgery.

Dr. Bonatti also uses a new type of heart-lung machine specially designed for use with robotic heart surgery, which is connected to the patient through an artery in the groin. A traditional heart-lung machine requires an opening in the chest.
When the patient is on the heart-lung machine, and the heartbeat is stopped, surgeons can sew extremely tight and accurate sutures with the robotic system. Research indicates that this technique adds to the longevity of the bypass, in contrast to other approaches in which the heart is kept beating.

Advantages of Minimally Invasive Surgery

The minimally invasive procedure eliminates the need for a large incision made down the sternum (breastbone) to access the heart, which reduces a patient's surgical trauma. Other potential patient benefits include:

Less pain (and need for pain medication)
Less scarring
Shorter hospital stay
Quicker recovery and return to normal activities, and even light sports, within two to three weeks after the intervention.
Less bleeding and need for blood transfusions
Lower risk of infection
The bypass grafts that are used can stay open and supply the heart with blood for a very long time. These so-called internal mammary arteries show durability rates in the 20- to 30-year range and are the best option for a patient with coronary artery disease.
No foreign material is implanted.
Except for aspirin, which the patient with coronary artery disease has to take anyway, no blood-thinning medication is necessary.

Why Come to the University of Maryland?

Dr. Bonatti, director of the University of Maryland Medical Center’s coronary surgery program, is one of the world's most experienced surgeons in using the da Vinci robot for heart surgery. The technique is sometimes referred to totally endoscopic coronary artery bypass (TECAB) because there are no incisions. He has performed more than 300 minimally invasive robotic heart surgeries, most of which were completely endoscopic (without an incision). He leads the Maryland Heart Center team that performs these state-of-the-art procedures.

Whom Do I contact for more information?

For more information or to schedule an appointment, please call 410-328-9169.

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.