Open heart surgery is a procedure that can be performed in two ways: the first is cutting the chest open (which is very invasive) the second is working on the heart around the ribs.
These options have been the same for over 50 years (!). However, they changed a year ago when a Turkish doctor successfully performed keyhole surgery on patients that needed a new aortic valve. Now it seems that this new and less invasive form of heart surgery is replacing the classic procedure.
How is this new procedure performed?
Alladin Yilmaz the cardiothoracic surgeon who developed the keyhole surgery uses two techniques. The first one is suitable for patients who have a one-branch coronary artery blockage.
These patients get a small incision that’s about 3-4 centimeters. This is called endo-ACAB (endoscopic atraumatic coronary artery bypass). The heart is still beating when this surgery is performed.
The second technique is for patients who have a blockage in multiple coronary arteries and is called endo-CABG (endoscopic coronary artery bypass grafting). These patients also get a small incision (3-4 centimeters) however the heart is stopped to perform the surgery and a machine connecting the heart and lungs is active during the procedure.
The benefits
Keyhole surgery is a minimally invasive form of surgery because it requires smaller incisions which reduces tissue damage and also reduces scarring. There is also a reduction in blood loss and it takes the patient less time to heal, the results after the operation are amazing. With this new procedure patients can leave the hospital in a week.
These benefits are in strong contrast with an open heart surgery, where there are a lot of risks included (for example irregular heartbeat, kidney failure, lung failure and more) and where the postoperative hospitalization and rehabilitation period can take somewhere between 3 to 6 months!
Since this procedure has only taken off recently there aren’t a lot of research papers comparing endo-GABG with a regular CABG procedure.
There is one review article that you can read here. The authors of this article concluded that the hospitalization period reduced increasingly and that post-operative risks were also lower. This implied that a total endo-CABG could be performed safely in selected centers for selected patients.
