Editorial note: this article has been revised for accuracy and clarity and has not been independently re-verified by a clinician. It is general information, not medical advice.

The days of long incisions are slowly falling into oblivion. In studies such as the BARI trial, coronary bypass surgery was found to give more lasting results than balloon angioplasty in certain patient groups, particularly people with diabetes. The right procedure for an individual depends on the pattern of blockages and other factors, and is decided together with the treating team. Surgeons are now devising ways to make it as less invasive as possible. Most of our bypass surgery is performed 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.

Minimal Access Bypass Surgery

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