Minimally invasive heart surgery - the safest treatment for heart disease.

One of the major concerns about somebody undergoing heart surgery is the risk of stroke and death. This results from the manipulation of the aorta and cardiopulmonary bypass which conventional heart surgery entails.

There is a new approach to coronary artery surgery which does not necessitate any handling of the aorta whatsoever. This is the concept of minimally invasive coronary artery bypass surgery where a small 5-6 cm incision is made on the left chest through which both internal mammary arteries are harvested and used to bypass all areas of the heart. This surgery does not need median sternotomy, use of the heart lung machine and in particular does not involve any handling of the aorta - the anaortic or no-touch aorta technic.

As a result, the risk of stroke and death is much reduced and the recovery following surgery is enhanced so that patients only need to spend 3-4 days in hospital and can get back to work within a week.

In comparison, coronary artery angioplasty and stenting, the percutaneous coronary intervention (PCI) approach, inevitably involves introducing guide wires, catheters, balloons, stents or other complex instrument into the aorta before they can be negotiated into the coronary arteries which start from the base of the aorta. There is always a risk of knocking off material from within the wall of the aorta, especially since it may be badly disease especially in older patients. This may result in stroke and silent stroke which has been detected in 15 to 32% of patients.

It is my believe that minimally invasive coronary artery bypass grafting as described is safer than PCI for patients with multi-vessel coronary artery disease.