Coronary artery disease is the most common form of heart disease, and the No. 1 cause of death in the United States, according to the American Heart Association. It occurs when coronary arteries -- the small blood vessels that supply blood and oxygen to the heart -- become blocked. This reduces or stops the flow of blood to the heart, depriving the heart muscle of oxygen.
For patients with severe blockages, coronary artery bypass surgery is a proven treatment option. In bypass surgery, surgeons remove or redirect a blood vessel from one part of the body and place it around the obstructed part of the coronary artery to bypass it and restore blood flow to the heart muscle. This vessel is called a graft, hence the other common name for this procedure -- coronary artery bypass graft or CABG.
Maryland Heart Center surgeons have helped pioneer the latest minimally invasive approaches for coronary artery bypass surgery, and are one of the first programs in the country and the first and only in Maryland to use the da Vinci robot for bypass surgery. These advances benefit patients in many ways, including smaller incisions and scars, fewer side effects and complications, less pain and risk of infection and a faster recovery.
In contrast to traditional bypass surgery, where the chest is cut open at the sternum (breastbone) to gain access to the heart, in the robot-assisted minimally invasive coronary artery bypass surgery the surgeon makes several small incisions between the ribs in which the arms of the robot and a small camera are placed.
While sitting at a computer console, the surgeon looks through two lenses, which provide a three-dimensional, 10-times-magnified image inside the patient's body. The surgeon's hands control the instrument arms to perform the procedure. The da Vinci robot has "wristed" instruments that mimic the movements of the surgeon's hands and wrists, providing the surgeon with excellent flexibility and precise motion control.
The da Vinci robot's "wristed" instruments provide a greater range of motion than the human hand while eliminating physician tremor.
In most cases, the surgeon will use (or harvest) one or both of the internal mammary arteries -- blood vessels on the inside of the chest cavity -- for the bypass, depending on the number of blocked arteries. Using the robotic arms, the surgeon redirects one end of the artery to the heart surface beyond the blockage, thus bypassing the blockage and increasing blood flow to the heart.
In addition to already being close to the heart, and easily accessible by the robotic arms, the internal mammary artery has the advantage of being resistant to cholesterol buildup, one of the major causes of artery blockages and coronary artery disease.
The heart remains beating throughout the robotic procedure, which is safer and poses fewer side effects than having a patient on a heart-lung machine to maintain circulation. Patients with one or two blocked arteries are candidates for this procedure.
In the robot-assisted procedure, small incisions are made between the ribs, which helps to reduce pain, scarring, blood loss and the risk of infection.
Robot-assisted minimally invasive coronary artery bypass surgery eliminates the need for a large (6-10 inch) incision made down the sternum (breastbone) to access the heart, which reduces a patient's surgical trauma. Other potential patient benefits include:
There are several unique advantages the Maryland Heart Center offers patients needing coronary artery bypass surgery. We have a highly active minimally invasive cardiac bypass program, and offer a wide range of the latest treatment options, some of which we helped to pioneer. These treatments include:
As a tertiary referral center, our program has experience dealing with high-risk patients who derive an even greater benefit from this less invasive approach.
Our extensive use of graft imaging techniques during and after the surgery virtually eliminates the chance that a surgical defect will result from this novel approach that compromises the function of the bypass graft. Finally, we are developing an extensive research experience in the effects of blood clotting during minimally invasive coronary artery bypass procedures that may be utilized to improve the long-term results of the graft without increasing the risks of bleeding during the surgery.
For more information on robot-assisted minimally invasive coronary artery bypass surgery, or to schedule an appointment, please call 410-328-9169.
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