Minimally invasive coronary artery surgery is also called limited access coronary artery surgery. It's being evaluated in several medical centers as an alternative to the standard methods for coronary artery bypass graft surgery (CABG). Like CABG, the surgery is done to reroute, or "bypass," blood around coronary arteries that are clogged by fatty buildups of plaque to improve the supply of blood and oxygen to the heart.

Two approaches are commonly used:

• Port-access coronary artery bypass (also referred to as PACAB or PortCAB)
• Minimally invasive coronary artery bypass (also called MIDCAB)

What is port-access coronary artery bypass (PACAB or PortCAB)?

In PACAB, your heart is stopped and your blood is pumped through an oxygenator or "heart-lung" machine to receive oxygen during the surgery. This is called "cardiopulmonary bypass." Then small incisions ("ports") are made in your chest. Chest arteries or veins from your leg are attached to the heart to "bypass" the clogged coronary artery or arteries. The surgical team passes instruments through the ports to perform the bypasses. The heart surgeon views these operations on video monitors rather than directly. Procedures are also being developed to replace damaged valves through limited access ports.

What is minimally invasive coronary artery bypass (MIDCAB)?

MIDCAB is used to avoid the heart-lung machine. It's done while your heart is still beating and is intended for use when only one or two arteries will be bypassed. MIDCAB uses a combination of small holes or "ports" in your chest and a small incision made directly over the coronary artery to be bypassed. The heart surgeon usually detaches an artery from inside the chest wall and re-attaches it to the clogged coronary artery farthest from the occlusion. The surgeon views and performs the attachment directly, so the artery to be bypassed must be right under the incision.

AHA Recommendation

The American Heart Association Council on Cardio-Thoracic and Vascular Surgery has been carefully monitoring these two procedures. Both surgeries appear promising but need more study to examine short- and long-term benefits. MIDCAB, for example, seems to be easier on the patient and less expensive than a coronary artery bypass graft. However, there may be complications that mean an open-chest procedure is needed. Neither procedure can be given an unqualified endorsement until more data on their effectiveness is obtained and analyzed. If these surgeries can be refined to the point where they're no more invasive than angioplasty, they could have a distinct advantage over angioplasty. However, at this point these types of surgery are more invasive than angioplasty and require general anesthesia.

Check with a large medical center in your area to find locations in your region where these procedures are being done.

Related AHA publications

• Heart and Stroke Facts
• About Your Bypass Surgery brochure