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What's so minimal about "minimally invasive" coronary bypass surgery?

MIDCAB: Benefits and Risks
Traditional open heart surgery and a minimally invasive bypass. Note that with MIDCAB surgery only a 2.5 inch (6 cm) opening between your ribs is necessary. 
Traditional open heart surgery and a minimally invasive bypass. Note that with MIDCAB surgery only a 2.5 inch (6 cm) opening between your ribs is necessary. 
HSW 2008

­If you've had MIDCAB or TECAB, you know that one of the best things about them is the reduced recovery time. The disadvantage to having your chest split open in traditional bypass surgery (aside from having your chest split open) is that it requires about a week to 10 days in the hospital alone and another two to three months of recovery time at home. Depending on your job, you may be able to work some limited hours during this period, but if you have a high-stress occupation or swing a hammer for a living you may not be able to work at all. With MIDCAB and TECAB, you'll only need a few days in the hospital, and most patients can resume work and their normal daily activities within two weeks.

You'll also experience less pain and, by virtue of that fact, need less pain medication, which is always a plus. And, you'll be glad to know that you also won't have an 8-inch scar down the center of your chest that screams, "Hey, I've just had open heart surgery!" Because your chest remains closed for business, you're also at less risk for infection. There's also little blood loss so you're unlikely to need a blood transfusion. Mortality rates for traditional bypass surgery are low -- about 1.5 to 2 percent. That's got nothing on MIDCAB and TECAB though -- they have only a 0.3 percent mortality rate.

If none of these reasons are convincing enough, the minimally invasive procedures also hit your pocketbook a little less. MIDCAB is generally about 25 percent less expensive than traditional bypass surgery. And, because of the reduced hospital stays and recovery time, you can be back at work and making the money you dropped for the surgery quicker -- a big deal for those paid largely on tips or commission.

So is minimally invasive bypass surgery the best thing since sliced bread? Not always. There are some risks involved, and some doctors don't believe the hype. Performing the surgery itself is more technically challenging than regular open heart surgery. And, it's a fairly new technique, which automatically makes it a little riskier than something that's been performed for more than 40 years. It also produces more stress on the heart, which can lead to low blood pressure -- this would need to be corrected after surgery with medication. About 10 percent of the time, the surgeon even needs to switch to traditional surgery midway because of an emergency.

Doctors Lawrence Bonchek and Daniel Ullyot of the Mid-Atlantic Heart Institute are on record in favor of traditional bypass surgery over MIDCAB and TECAB. Why? They maintain that if it ain't broke, don't fix it. Open heart surgery has been a tried and true method for a lot of years. There are thousands of experienced surgeons who can perform it on a wide variety of patients. They argue that it's easier to teach and learn and has a lower incidence of complications. They also make a case that the cost savings are overblown by companies that manufacture the equipment used in MIDCAB and TECAB.

If you're in need of a coronary bypass, be your own advocate and ask a lot of questions. Get more than one opinion and you'll be able to make an informed decision about whether a minimally invasive procedure is right for you.