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Chapter 2

Cardiovascular Care

 57

Minimally Invasive Direct

Coronary Artery Bypass

Minimally invasive direct coronary

artery bypass surgery (MIDCAB) also

known as minimal or limited access

CABG, refers to procedures that

use alternative incisions to standard

median sternotomy. MIDCAB is

performed through a limited anterior

thoracotomy and generally without

cardiopulmonary bypass. In many

instances, this approach typically

involves only an anastomosis between

the left internal mammary artery

(LIMA) and left anterior descending

(LAD) coronary artery or some use

of a composite graft off the LIMA to

other coronary arteries.

The MIDCAB Procedure

The MIDCAB procedure is performed through a short incision in the left

chest cavity. The internal mammary artery is sewn to the LAD artery in the

front of the heart, as shown here.

Left internal

mammary artery

Left anterior

descending artery

Atherectomy

Atherectomy is the use of a small, rotating knife to remove fatty deposits from blocked coronary arteries. The

catheter is advanced to the arterial obstruction, the knife is positioned precisely on the fatty deposit, and then

the fatty deposit is shaved off the artery wall.

Cutting

blade

Atheromatous

debris

Guide wire

Drive cable

Diamond-coated

burr

Guide wire

Cutter

Balloon

Nose cone

(collection

chamber)

Guide wire

T R A N S L UM I N A L E X T R A C T I O N

C A T H E T E R

R O T A B L A T O R

A T H E R O C A T H