Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  57

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.

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.

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.

Drive cable

Cutter

Cutting blade

Balloon

Atheromatous debris

Nose cone (collection chamber)

Diamond-coated burr

Guide wire

Guide wire

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