Minimally Invasive Direct Coronary Artery Bypass (MID-CAB)
Sutter Heart & Vascular Institute

Why is the doctor performing this surgery?
To bypass, or go around, the obstruction caused by a coronary (heart) artery filled with a clot or with plaque (atherosclerosis). If the obstruction is not bypassed, the heart muscle beyond the obstruction is denied oxygen and nutrients. It differs from traditional coronary artery bypass surgery because it is a less invasive procedure, using smaller incisions to improve stability and to speed recovery, and does not require the use of a heart-lung machine.

What is the surgery?
Minimally Invasive Direct Coronary Artery Bypass is known as "MID-CAB." Minimally invasive means that the surgeon accesses the heart with less trauma, and thru a smaller incision, than traditional bypass surgery. Most often, the left anterior descending (LAD) coronary artery will be bypassed, using the left internal mammary artery (LIMA) as the bypass graft. The steps are:

• The left internal mammary artery (the graft artery for the bypass) is reached thru a 4-6 inch incision on the left side of the chest.
• Medications are given intravenously to slow the heart down for the surgery.
• A special stabilizing device is used to keep the involved portion of the heart as still as possible for the surgeon to work.
• Blood flow thru the left anterior descending artery stops as this artery is clamped off.
• The lower end of the internal mammary artery is detached, then reattached to the anterior descending artery just below its blockage.
• Blood flow then bypasses the blockage as it travels thru the internal mammary artery, supplying vital oxygen and nutrients to the heart muscle beyond the blockage.

Where is the surgery performed?
In the Operating Room (OR), under general anesthesia.

How long does this surgery take?
MID-CAB usually takes about 2 hours.

Which facilities perform this procedure?
Sutter Medical Center, Sacramento