>> Minimally Invasive Coronary Artery Surgery
Minimally Invasive Coronary Artery Surgery




“Recovery after coronary bypass is unbelievably shortened with return to work under 10 days”

- Dr Sathyaki Nambala
• No Sternotomy or cutting through the breast bone.
• Left chest approach allows for rapid healing without woundcomplications.
• Ideal for diabetics and the elderly. Infection rates approach zero and bone infection is eliminated.
• All vessels and blocks can be treated safely, making this procedure a complete operation not comparable to any other older technique.
• Ultrashort Hospitalization and Rapid Recovery possible with advanced technology and superior unique technique. 
Coronary Bypass gets closer to day care surgery

At Apollo Hospital, Bangalore the focus has always been to provide patient centric health care of exacting standards. In achieving this we adopt cutting edge techniques and technologies that are on par with the finest hospitals in the world. This time around we bring the best in the treatment of coronary artery disease.

Coronary artery disease that requires coronary artery bypass or CABG as iscommonly referred to, somehow strikes fear. For decades now, a bypass operation has been performed by splitting or cutting through the breast bone or sternum. The root cause of the fear is the time it takes for one to recover from a heart bypass operation. MICAS or MICS CABG is a safe and complete operation that changes outcomes entirely.

State Of the Art

MICS CABG or MICAS stands for minimally invasive coronary artery surgery. It is a relatively new and advanced technique of performing coronary bypass for coronary artery disease. In this technique the heart is approached through the side of the left chest via a small 4cm incision. This cut is placed just under the nipple. The chest is entered between the ribs without cutting any bones and by splitting the muscle.

Similar to a regular heart surgery the operation is performed using all arteries or a combination of arteries and veins removed from the leg. The vessel from the leg in this operation is also removed endoscopically without cutting the skin over the legHighly advanced instrumentation and advanced techniques allow for the operation to be performed very safely.

MICS CABG has several advantages over the traditional technique. First and foremost is the fact that no bones are cut. This has several advantages in reducing pain, retaining function and a positive effect on breathing. Unlike traditional heart surgery return to normal life including driving or other activities is not disrupted and can be started almost immediately.

Second, blood loss is almost negligible eliminating blood transfusion in most and eliminating blood borne infection.

Third, all infections are reduced.

whether it be wound infections or post surgical lung infection. This makes the procedure ideal in diabetics and older patients who have poor resistance to infection.

Fourth, the incision is so cosmetic and measures just 2 – 3 inches that it’s practically impossible to tell that a heart operation has been done. Doctor’s including physicians and cardiologists express surprise and disbelief that a heart operation has been performed through such a small opening.

All these benefits put together make for ultra short hospitalization and recovery. The best part is that unlike previous techniques, all the blocks irrespective of their location on the heart can be bypassed in a safe and and predictable manner.EVH in skilled hands with advanced equipment is safe, reliable and superior to the open technique

Frequently Asked Questions

1. What is MICS CABG?

This is a technique of coronary artery bypass or CABG where in the entire operation is performed from the side of the chest (on the left) through an incision that is about 2 inches.

2. How does it differ from conventional CABG?e

Conventional CABG or Coronary artery bypass requires the breast bone or sternum to be cut into half. Recovery from conventional bypass surgery requires a longer duration upto 8 weeks as the bone needs to heal. In MICS CABG, the operation is performed through the side of the chest wall. No bones are cut and healing is rapid. Healing is usually complete in ten days.

3. Will MICS CABG help me leave the hospital early and get back to work?

Definitely yes! This is exactly the reason to do this operation. Hospital stay is as short as 2 days and most patients get back to work or normal life in 10 days. (A regular operation requires 2 months to recover from)

4. Is it a beating heart operation?

Yes, its an offpump or beating heart operation. The support of a pump may rarely be required but the operation is still performed on the beating heart. Pump support may particularly be used when the heart is weak.

5. Are MICS CABG and MIDCAB one and the same?

No, they are not the same. MIDCAB is an old technique where only one or two vessels can be grafted. Its an incomplete operation and is no longer performed. Its often confused with the modern MICS CABG if one is unaware about recent developments.

6. I am a diabetic. Is MICS CABG appropriate for me?

Absolutely. You may be the ideal candidate for MICS as infection rates are almost eliminated. The quality of your vessels will dictate whether you are suitable for this technique and your surgeon is the best judge.

7. What is the risk of infections after MICS CABG?

The risk of infection is close to zero. All infections are reduced dramatically in MICS CABG compared to conventional CABG even in diabetics.

8. I am a smoker/asthmatic. Is MICS CABG still an option for me?

Yes. It could be the ideal option for you. It's best for your surgeon to take that decision along with your respiratory therapist.

9. My doctor at the clinic I go to says he is unaware of MICS and that it could be dangerous. Is this true?

Most doctors are unaware of latest advances in heart surgery. In its current state MICS is very safe provided its performed by someone specially trained in MICS. Please ask your doctor to speak to us if he wants to know more about minimal access coronary bypass.

10. Are all patients with multivessel blocks candidates for MICS CABG?

No, not all patients with multivessel coronary blocks are candidates. Those with extensive disease or very poor heart function are not suitable for this technique. Your heart surgeon is the bestperson to decide whether you are a candidate or not for this kind of operation.

11. Is MICS CABG performed in all centers?

No, not all heart surgeons are trained inMICS. Including ours, there are only a handful of centers all over the world that are capable of performing MICS safely. It may be in your best interest to ask yoursurgeon where he trained in MICS so as to ensure that he or she is not experimenting on you.

12. Are heart surgeons in Apollo trained to do MICS CABG?

Yes. Both our surgeons are well trained in MICS. Dr Sathyaki Nambala initiated the minimal access program and has more than eight years of experience in the technique. His early experience comes from having worked at the Harvard Medical School in Boston, USA. His colleague DrAdilSadiqtrained at the Emory University, USA in minimal access techniques including robotic surgery. Both centers have more than a decade of experience and are well known for MICS.

Endoscopic Vein Harvesting

 Endoscopic vein harvesting (EVH) adds benefit to MICS CABG. State of the art equipment ensures quality with exceptional patient comfort EVH is a technique of harvesting the leg vein used as bypass conduits with an endoscope.

Apollo Hospital, Bangalore has the most advanced and the latest equipment for this procedure. This advanced equipment allows the leg vein to be removed without injury unlike in other centers with old outdated instruments. The leg is not cut open unlike the old technique and this benefits in rapid wound healing while eliminating the possibility of leg wound infection. Added to that is a skilled team that’s had more than eight years of experience using advanced equipment on a daily basis and the results are outcomes that are unmatched in the country.

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