Minimally Invasive Heart Bypass Surgery
Performing coronary artery bypass surgery (CABG) without opening up the chest cavity might sound like a description of a cardiology procedure of the future — but at Emory, this groundbreaking advance in the surgical treatment of heart disease is now a reality. The “hybrid” procedure combines interventional cardiology with surgical techniques.
Cardiothoracic surgeon Thomas Vassiliades, MD, one of the nation’s pioneers in minimally invasive heart surgery, has joined the Emory Heart & Vascular Center. Dr. Vassiliades is nationally known for developing robotics assisted endoscopic techniques which allow coronary artery bypass surgery (CABG) to be performed using small incisions between the ribs rather than an open-chest approach with a large incision through the sternum. The advantages to this approach, called Endoscopic Atraumatic Coronary Artery Bypass (Endo-ACAB), are numerous, according to Dr. Vassiliades.
“The heart/lung machine is usually the culprit in morbidity resulting from CABG. But Endo-ACAB is performed off-pump,” he notes. “Also, the incision through the sternum tends to hurt patients — and worry them — the most. The endoscopic approach means there is no chest incision and no problem with a large incision not healing correctly,” he says. Dr. Vassiliades adds that most patients are able to leave the hospital within 48 hours and return to full activity, including work, in two to three weeks, rather than the two to three months needed for recovery after traditional CABG surgery.
"I have performed over 500 Endo-ACAB procedures, and the results for my patients have been extremely positive," Dr. Vassiliades says. One recent patient, attorney Harold Goldberg, traveled from his home in Syracuse, New York, to Emory especially for the procedure.
“I had a blocked coronary artery that could not be repaired by angioplasty. I did not want the traditional bypass surgery and medication had not provided the long-term result I needed so my cardiologist recommended that I come to Emory. Given the choice of having my sternum broken and this, the choice was obvious to me,” says Mr. Goldberg, 54. Three days after Dr. Vassiliades performed his Endo-ACAB procedure, Mr. Goldberg was ready to return home and declared he “felt great”.
More than 1.3 million patients each year in the United States receive coronary artery revascularization treatment, including CABG and angioplasty (which uses a balloon-tipped catheter to push aside blockages in heart arteries). Dr. Vassiliades believes the minimally invasive approach can help many of these people who are candidates for bypasses, or who need a combination of bypasses and angioplasty.
“A new hybrid treatment option combines the best of surgical and catheter-based therapy to treat patients in a minimally invasive manner. During a hybrid procedure, I perform the closed chest bypass and then an interventional cardiologist inserts the stents,” says Dr. Vassiliades. “By combining Endo-ACAB with angioplasty and stents, we want to be able to take care of all blockages a patient has, keep the chest intact, and avoid the expense and risks of the heart/lung machine — all with one procedure.”
Currently, Emory is the only medical center in Georgia where the Endo-ACAB procedure and the “hybrid” approach are performed. Nationally, fewer than ten U.S. institutions use these techniques, according to Dr. Vassiliades.
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