Can a coronary artery bypass graft be performed minimally invasively?

Can coronary artery bypass graft be performed minimally invasive? Yes, coronary artery bypass grafting can be performed minimally invasive. It's important to understand that when we say minimally invasive, whether we are talking about the size of the incision or whether we are talking about the use of the heart-lung machine. Now, the procedure of coronary bypass grafting can be done with the help of the heart-lung machine or the cardiopulmonary bypass machine, and that is the most common way of performing this procedure, particularly in the Western world. Most bypass operations are performed with the help of the heart-lung machine, and in this process, the patient's heart is connected to the heart-lung machine. the procedure is performed on an arrested heart and the machine does the job of the heart and the lungs while the operation is being performed. And that is commonly called the on-pump coronary artery bypass grafting. However, there's a different way of performing the same operation. It's called off-pump coronary artery bypass grafting or the beating heart bypass operation, which is the usual or common way of performing this procedure in the Eastern world. and the procedure essentially is performed without the aid of the heart-lung machine. In this operation, a special device called the octopus is used, which stabilizes the area where you're gonna put the bypass graft, and the rest of the heart continues to beat, which essentially means that you are performing this operation in a more physiological manner because you do not stop the heart and you do not stop the circulation and the machine does not take over the role of the heart and the lungs. So, you know, it is debatable which of the two is better. I think the most important thing is that whoever is doing the operation has to be good at doing either on or off-pump operation. And I think more importantly is the expertise that matters and not generally the technique which makes the difference. Although there is some evidence to suggest that in patients who have lots of comorbidities or who have a potential high risk for complications, medications, they do better if you offer them off-pump or beating heart bypass operation. So the other aspect of minimally invasive is the size of the incision through which we do the operation. A conventional triple vessel coronary bypass operation is performed through the midline in which the breastbone is cut open for us to have access to the full heart. And that is the commonest way of performing this procedure. However, if patients have got a single vessel narrowing and have been referred for a bypass operation, then they can have this operation through a small incision about two and a half centimeters to three centimeter on the left side of the chest. And that procedure is called a mid gap. In some centers, the same procedure can be performed with the help of a robot or can be performed endoscopically without making big incisions on the chest. These procedures are still evolving and conventional operation through the midline is deemed as the standard procedure for performing coronary artery bypass grafting.