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Minimally Invasive Coronary Artery Surgery




“Recovery after coronary bypass is unbelievably shortened with return to work under 10 days”

- Dr Sathyaki Nambala
• No Sternotomy or cutting through the breast bone.
• Left chest approach allows for rapid healing without woundcomplications.
• Ideal for diabetics and the elderly. Infection rates approach zero and bone infection is eliminated.
• All vessels and blocks can be treated safely, making this procedure a complete operation not comparable to any other older technique.
• Ultrashort Hospitalization and Rapid Recovery possible with advanced technology and superior unique technique. 
Coronary Bypass gets closer to day care surgery

At Apollo Hospital, Bangalore the focus has always been to provide patient centric health care of exacting standards. In achieving this we adopt cutting edge techniques and technologies that are on par with the finest hospitals in the world. This time around we bring the best in the treatment of coronary artery disease.

Coronary artery disease that requires coronary artery bypass or CABG as iscommonly referred to, somehow strikes fear. For decades now, a bypass operation has been performed by splitting or cutting through the breast bone or sternum. The root cause of the fear is the time it takes for one to recover from a heart bypass operation. MICAS or MICS CABG is a safe and complete operation that changes outcomes entirely.

State Of the Art

MICS CABG or MICAS stands for minimally invasive coronary artery surgery. It is a relatively new and advanced technique of performing coronary bypass for coronary artery disease. In this technique the heart is approached through the side of the left chest via a small 4cm incision. This cut is placed just under the nipple. The chest is entered between the ribs without cutting any bones and by splitting the muscle.

Similar to a regular heart surgery the operation is performed using all arteries or a combination of arteries and veins removed from the leg. The vessel from the leg in this operation is also removed endoscopically without cutting the skin over the legHighly advanced instrumentation and advanced techniques allow for the operation to be performed very safely.

MICS CABG has several advantages over the traditional technique. First and foremost is the fact that no bones are cut. This has several advantages in reducing pain, retaining function and a positive effect on breathing. Unlike traditional heart surgery return to normal life including driving or other activities is not disrupted and can be started almost immediately.

Second, blood loss is almost negligible eliminating blood transfusion in most and eliminating blood borne infection.

Third, all infections are reduced.

whether it be wound infections or post surgical lung infection. This makes the procedure ideal in diabetics and older patients who have poor resistance to infection.

Fourth, the incision is so cosmetic and measures just 2 – 3 inches that it’s practically impossible to tell that a heart operation has been done. Doctor’s including physicians and cardiologists express surprise and disbelief that a heart operation has been performed through such a small opening.

All these benefits put together make for ultra short hospitalization and recovery. The best part is that unlike previous techniques, all the blocks irrespective of their location on the heart can be bypassed in a safe and and predictable manner.EVH in skilled hands with advanced equipment is safe, reliable and superior to the open technique

Frequently Asked Questions

1. What is MICS CABG?

This is a technique of coronary artery bypass or CABG where in the entire operation is performed from the side of the chest (on the left) through an incision that is about 2 inches.

2. How does it differ from conventional CABG?e

Conventional CABG or Coronary artery bypass requires the breast bone or sternum to be cut into half. Recovery from conventional bypass surgery requires a longer duration upto 8 weeks as the bone needs to heal. In MICS CABG, the operation is performed through the side of the chest wall. No bones are cut and healing is rapid. Healing is usually complete in ten days.

3. Will MICS CABG help me leave the hospital early and get back to work?

Definitely yes! This is exactly the reason to do this operation. Hospital stay is as short as 2 days and most patients get back to work or normal life in 10 days. (A regular operation requires 2 months to recover from)

4. Is it a beating heart operation?

Yes, its an offpump or beating heart operation. The support of a pump may rarely be required but the operation is still performed on the beating heart. Pump support may particularly be used when the heart is weak.

5. Are MICS CABG and MIDCAB one and the same?

No, they are not the same. MIDCAB is an old technique where only one or two vessels can be grafted. Its an incomplete operation and is no longer performed. Its often confused with the modern MICS CABG if one is unaware about recent developments.

6. I am a diabetic. Is MICS CABG appropriate for me?

Absolutely. You may be the ideal candidate for MICS as infection rates are almost eliminated. The quality of your vessels will dictate whether you are suitable for this technique and your surgeon is the best judge.

7. What is the risk of infections after MICS CABG?

The risk of infection is close to zero. All infections are reduced dramatically in MICS CABG compared to conventional CABG even in diabetics.

8. I am a smoker/asthmatic. Is MICS CABG still an option for me?

Yes. It could be the ideal option for you. It's best for your surgeon to take that decision along with your respiratory therapist.

9. My doctor at the clinic I go to says he is unaware of MICS and that it could be dangerous. Is this true?

Most doctors are unaware of latest advances in heart surgery. In its current state MICS is very safe provided its performed by someone specially trained in MICS. Please ask your doctor to speak to us if he wants to know more about minimal access coronary bypass.

10. Are all patients with multivessel blocks candidates for MICS CABG?

No, not all patients with multivessel coronary blocks are candidates. Those with extensive disease or very poor heart function are not suitable for this technique. Your heart surgeon is the bestperson to decide whether you are a candidate or not for this kind of operation.

11. Is MICS CABG performed in all centers?

No, not all heart surgeons are trained inMICS. Including ours, there are only a handful of centers all over the world that are capable of performing MICS safely. It may be in your best interest to ask yoursurgeon where he trained in MICS so as to ensure that he or she is not experimenting on you.

12. Are heart surgeons in Apollo trained to do MICS CABG?

Yes. Both our surgeons are well trained in MICS. Dr Sathyaki Nambala initiated the minimal access program and has more than eight years of experience in the technique. His early experience comes from having worked at the Harvard Medical School in Boston, USA. His colleague DrAdilSadiqtrained at the Emory University, USA in minimal access techniques including robotic surgery. Both centers have more than a decade of experience and are well known for MICS.

Endoscopic Vein Harvesting

 Endoscopic vein harvesting (EVH) adds benefit to MICS CABG. State of the art equipment ensures quality with exceptional patient comfort EVH is a technique of harvesting the leg vein used as bypass conduits with an endoscope.

Apollo Hospital, Bangalore has the most advanced and the latest equipment for this procedure. This advanced equipment allows the leg vein to be removed without injury unlike in other centers with old outdated instruments. The leg is not cut open unlike the old technique and this benefits in rapid wound healing while eliminating the possibility of leg wound infection. Added to that is a skilled team that’s had more than eight years of experience using advanced equipment on a daily basis and the results are outcomes that are unmatched in the country.

Patient Testimonials

Angioplasty and Stenting

This is a procedure used to restore the blood flow through a blocked artery. Dilating the blockage with balloon is called Balloon Angioplasty and deploying a stent is called Stenting. The technical name for balloon angioplasty is percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI).

Know More

A tiny plastic tube (guiding catheter) is passed through the groin or hand till the origin of coronary arteries, and then a thin soft wire (guide wire) is passed through this tube and is negotiated across the block. Then another tube having a balloon at one end is passed over this wire up to the site of blockage. At this point the balloon is inflated to widen the artery by pushing the plaque against the wall of the artery thereby restoring the blood flow. Now-a-days after dilating with the balloon, a stent is deployed to keep the artery open.

A stent is a tiny metallic mesh tube looking like a spring. We have two types of stents i.e. drug eluting and bare metal. The advantage of the drug eluting stent is that they have been able to achieve a very low reblockage rate of about 0-5% which used to be about 25-30% with bare metal stents.

The stent remains in the body throughout life. The only problem is development of reblockage at the same place where the stent is deployed and this can be minimized by the use of drug eluting stents. Stents cannot be removed after deployment. After 1 to 3 months the endothelial layer forms over the stent and then they become a part of our body.

Keyhole Approaches
For some surgical procedures, an endoscopic or "keyhole" approach may be performed. This approach may also be referred to as port access surgery or video-assisted surgery. The port access surgery technique allows surgeons to use one to four small (5 - 10 mm) incisions or "ports" in the chest wall between the ribs. An endoscope or thoracoscope (thin video instrument that has a small camera at the tip) and surgical instruments are placed through the incisions. The scope transmits a picture of the internal organs on a video monitor so the surgeon can get a closer view of the surgical area while performing the procedure.

Types of surgeries that may be performed using the innovative port-access or "keyhole" approach include
  • CABG surgery
  • Valve surgery
  • Bi-ventricular pacemaker lead placement on the surface of the left ventricle
  • Minimally invasive surgery for atrial fibrillation: Specialized instruments are used to create new pathways for the electrical impulses that trigger the heartbeat. Unlike traditional surgery for atrial fibrillation, there is no large chest wall incision, and the heart is not stopped during the procedure.
Some types of thoracic surgery

Video-assisted thoracoscopy (VATS), also called the thoracoscopy or pleuroscopy, is a minimally invasive surgical technique that may be used during some types of thoraicic surgeries, such as partial resection of the lung, lung biopsy, lobectomy, drainage of pleural effusions, or pericardial and mediastinal biopsies.

Cardia Arrhythmia

Cardiac Arrhythmia, or an irregular heartbeat, is a serious but treatable condition . Arrhythmias occur when the electrical impulses, in the heart, which coordinate the heartbeats don't function properly, causing the heart to beat too fast, too slow or irregularly.

Types of Arrhythmias

Paroxysmal Supra-Ventricular Tachycardia [PSVT], Atrial flutter, Atrial Fibrillation, Ventricular Tachycardia, Ventricular Fibrillation.

Causes of arrhythmias

From Hypertension, Ischemic heart disease, Valvular heart disease, Cardiomyopathies, Sinus node disease, Tumors, Pericarditis, COPD (Chronic Obstructive Pulmonary Disease), Thyroid Disease, Alcohol abuse, Vagal stimulation, Smoking, Modern day life styles etc.


In order to diagnose an arrhythmia, doctors order specific tests, depending on the type of the arrhythmia that is suspected. In addition to the blood tests, a doctor may order:

• Electrocardiogram / Echo-cardiogram.

• 24 hour electrocardiogram using a device called Holter monitor.

Electrophysiology Studies (EP Diagnostic Studies) help to locate the origin of the rhythm disorder better and determine the best treatment.

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