One of the greatest breakthroughs in medicine occurred on May 2, 1960, when Dr. Robert Goetz performed the first coronary artery bypass surgery at the Albert Einstein College of Medicine-Bronx Municipal Hospital Center. Prior to that first surgery, cardiac patients who were diagnosed with occluded coronary arteries had few options for treating their disease. Since then, a number of other exciting surgical advances have occurred that have made treating heart disease easier on the patient, promoting faster healing and less-complicated recoveries.
The Current State of Heart Surgeries
In 2006, more than 690,000 open heart surgeries were performed in the United States. These included surgeries to correct and repair defective valves as well as coronary artery bypass surgery. As recently as 70 years ago, these surgeries would have been impossible. The heart lung machine had yet to be invented, allowing surgeons to temporarily stop and start the heart. Prior to its invention, the longest a heart could be stopped was 30 to 40 minutes---not enough time to complete extensive surgery.
Since then, a number of minimally invasive surgical procedures have been developed that allow surgeons to perform a variety of surgeries, making smaller incisions that leave smaller scars, decrease the chance of infection, are less painful to the patient and require shorter hospital stays. These include minimally invasive direct coronary artery bypass, off-pump coronary artery bypass, videoscopic surgery and robotic-assisted heart surgery.
Minimally Invasive Direct Coronary Artery Bypass
Minimally invasive direct coronary artery bypass (MIDCAB) surgery allow surgeons to perform coronary artery bypass surgery through a small 2- to 3-inch incision between the ribs. It's most effective when only one or two bypasses are needed and are located in the front of the heart.
Off Pump Coronary Artery Bypass
Off pump coronary artery bypass (OPCAB) surgery, can often be done in conjunction with MIDCAB surgery without stopping the heart. Surgeons use special types of medical equipment that hold the heart still long enough to complete the procedure. The benefit is that expensive heart lung machinery and blood perfusionists are not needed, which helps to speed the patient's recovery and lower the price of the surgery.
Videoscopic Surgery
Videoscopic surgery allows surgeons to repair certain types of vascular problems by running a long, thin endoscope through a half-inch port between the ribs. Several other ports are made to insert surgical instruments. All of the work is managed through a console by the surgeon without having to open the chest cavity. The patient is connected to a heart lung machine, but instead of the tubes exiting an open chest cavity as in traditional bypass surgeries, special types of tubes are threaded through arteries and veins from the groin up into the heart.
Robotic Assisted Heart Surgery
For heart procedures that require even greater levels of precision, surgeons can use robotic assisted heart surgery. After making a series of small incisions between the ribs, they insert a specialized surgical robot. While sitting at a console, the surgeon manipulates the robot through a series of remote hand movements. The robots allow the surgeon to access areas that would normally be inaccessible to human hands or surgical instruments. Robotic assisted heart surgery is useful for coronary artery bypass surgery (called RACAB), repairing foramen ("holes"), septal defects, removal of tumors, valve placement and repair and placing leads for pacemakers and defibrilliators.
