In a pioneering accomplishment, doctors at Fortis Hospitals, Bangalore, India, put a 46-year-old woman suffering with coronary artery disease to quick recovery with minimally-invasive trans-abdominal Coronary Artery Bypass Graft (CABG). The procedure was performed by making only a small incision in the upper abdomen, sparing the breast bone or the chest wall completely.
According to a Fortis release, the major advantages of the procedure are: Dramatically reduced post-operative pain and less blood loss – which means faster recovery and less ICU stay; both the internal mammary arteries from under the breast bone and the gastroepiploeic artery from around the stomach can be harvested to their maximal lengths, which can result in a bypass surgery with multiple arterial grafts. It means the operation can last for the patient’s entire life if he or she looks after their lifestyle and takes regular medication; it is particularly advantageous for diabetic patients as no bones are cut and recovery is easier; it is also cosmetically beneficial since scarring is minimal; and it applies to a very large number of patients and hence has the potential to create a whole new surgical path for a CABG, globally.
“The surgery is a step towards further strengthening our expertise in minimally invasive CABG and is a trendsetter in the realm of minimal access bypass graft. It is ideal for single graft procedures but can also be done on patients who need up to two to three grafts. This procedure is immensely beneficial for patients who have co-morbid conditions like diabetes, respiratory problems or are obese,” explains Vivek Jawali, chairman, Cardiovascular Sciences, Fortis Hospital.
The patient, a resident of Bidar, had come to Fortis Hospitals seeking treatment for coronary artery disease. Conventionally, a block in the coronary artery would be treated by bypass graft that would necessitate opening up the chest on the left side or cutting the sternum (breast bone). In this case, however, the team of specialist cardiothoracic surgeons, led by Murali Manohar, under the expert guidance of Vivek Jawali, performed the innovative trans-abdominal CABG. A small incision was made in the upper abdomen, just under the sternum (chest bone) to reach the heart and a bypass was created by grafting the left internal mammary artery to the left anterior descending (LAD) artery.
This procedure, also called the sternal sparing subxiphoid approach for minimal access CABG, is the least invasive of all minimal access CABG’s and a one-of-its-kind surgery ever done in India. There is a dramatic reduction in pain compared to an open bypass which involves bone cutting with significant blood loss. This particular approach is uncommon around the world because of the technical expertise and skill required to perform such a surgery.
This is also an ’off-pump surgery’, which means there is no need to place the patient on a heart lung machine and it involves stabilising the beating heart while grafting the vessels. It is especially advantageous in elderly patients, those with lung diseases and renal dysfunction. The internal mammary artery from beneath the breast bone and the gastro epiploeic artery from the abdomen can be used as conduits for the bypasses as multiple arterial grafts can last lifelong if the patient takes good care of their life style.
In this particular patient, the trans-abdominal approach was also adopted for cosmetic reasons as scarring is minimal compared to a conventional bypass graft surgery.