45 / 56
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