The days of long incisions are slowly falling into oblivion. Coronary bypass surgery has been proved to be clearly longer lasting than angioplasty more so in diabetics as concluded by the BARI trial. Surgeons are now devising ways to make it as less invasive as possible. We do around 99% of our bypass surgery on a beating heart through small incisions. The different choices available are

Mini Bypass Surgery

The length of the incision is 8-10cm and the lower part of the chest bone is divided partially. The bypass surgery is done on a beating heart using a vacumm stabilizer. Multivessel bypass procedures can be done. The advantages are less pain, low risk of infections, and faster recovery. The only contraindication to this procedure are poor heart function, emergency bypass surgery and morbid obesity.

Minimally invasive direct coronary artery bypass (MIDCAB)

Done through a lateral thoracotomy ( incision through the rib spaces) ap plied to do a single vessel bypass. This is used only for left internal mammary artery(LIMA) to the left anterior descending artery(LAD) graft. The length of the incision is 6-8cm. The icsion is now being tried for multivessel bypass surgery by some groups but the initial results are questionable, long term data will tell us if it is better than conventional or Mini bypass. The other drawback is that thoracotomy incisions are clearly more painful than sternotomy incisions.

Totally endoscopic bypass surgery

Done with the use of the Robot. This is new technology and is currently in its early stages with time it will be more used and the long term results will be available for comparison with standard techniques.