Minimally Invasive CABG: Understanding Advanced Bypass Surgery | Dr. Manoj Pradhan

Duration: 5:44 860 transcript words EN summary

Video summary

Dr. Manoj Pradhan, a senior consultant cardiothoracic surgeon at Manipal Hospital, discusses the significant evolution in cardiac surgery that has transformed patient outcomes from life-threatening procedures to routine treatments where survival is expected. The most common operation performed is bypass surgery, which creates new pathways for blood flow around blocked arteries to prevent chest pain and reduce the risk of heart attacks. While angioplasty with stenting is effective for simpler blockages, it is not a universal solution; complex cases involving diabetes, multiple blockages in the same artery, heavy calcium buildup, or recurrent stent failures often require bypass surgery instead. The gold standard for these procedures is currently total arterial bypass performed on a beating heart, which avoids the use of heart-lung machines and utilizes arteries from the chest wall and hand to create durable grafts that can last 25 to 30 years. Advances in this field include minimally invasive coronary artery bypass techniques, which utilize smaller incisions to reduce pain and speed up recovery, though these are suitable for only about 10% of patients depending on their specific condition. For more complex cases requiring multiple grafts, a standard midline incision remains necessary, while robotic technology is often misunderstood as performing the entire surgery; in reality, robots currently assist only in harvesting arteries through small separate cuts, with the actual connection of vessels still performed manually by the surgeon under direct vision. Despite the growing interest in advanced techniques like robotics and minimally invasive approaches, Dr. Pradhan emphasizes that approximately 90% of patients will still undergo standard bypass surgery due to the complexity of their cases or anatomical limitations. The long-term benefit of a well-maintained bypass graft is substantial, offering decades of freedom from additional procedures compared to stents, which typically last around ten years before facing multiple blockages. Ultimately, current surgical strategies are centered on maximizing patient longevity and quality of life by selecting the most appropriate method—whether beating heart surgery, minimally invasive approaches, or standard techniques—for each individual's unique needs.

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Hello, I'm Dr. Manoj Pradhan. I'm a senior consultant cardiothoracic surgeon in Manipal Hospital. And today I'm going to talk to you all about advances in cardiothoracic surgery that impact every one of us in the routine life. So, what are the type of procedures that we are now talking of? When you first spoke of cardiac surgery, it was always that oh God, I don't know whether I'm going to survive. Now we have come at a point where cardiac surgery is taken for granted that everything will go as planned and there should be no problem. And that is how it is. So, what are the commonest operations that are done as part of this? A bypass surgery or a multiple bypass surgery is a commonest procedure that we do on a daily basis. Now, when we talk of bypass surgery, it is meant to bypass the obstruction in the arteries and we create a new pathway for the blood to flow. This helps us two ways. One is to prevent chest pain or angina that patients have, but more importantly, they prevent the chances of a heart attack, minor or major. Now, people generally feel now that you don't need to do bypass surgery because angioplasty with stenting takes care of everything. Unfortunately, this is far from true because what happens with angioplasty is the simpler ones can be done without a problem. The more complex blockages, which are seen in diabetics, multiple blockages in the same artery or too much calcium in the artery or someone who has had an angioplasty and stent done before and has got a blockage of the stent or new blockages which cannot be treated by a stent in which case they will need a bypass surgery. So what is the best bypass surgery that you can have? It is a total arterial bypass on a beating heart which means that the surgeon does not stop the heart, does not connect the heart lung machine and does the operation. When you have such an operation, normally we use arteries from the chest wall which are called mammary arteries and arteries from the hand which are called the radial arteries. Occasionally when the arteries are very bad or very small, we will need to use the veins from the leg. Now, what are the advances in this? The advances is what we call as minimally invasive coronary artery bypass. So minimally invasive coronary artery bypass is done by taking smaller incisions which heal faster and it cannot be done for each and every person but we select the patients who can have it and when they have it, generally the response of the patient is very good because pain is smaller, the incision is smaller and generally people are happier with that. However, if a patient needs four and five bypass grafts, you will need to do it in the standard way which is done from a incision in the center of your chest which is called a midline incision like this. For the radial artery harvesting which is what is the artery from the hand, we use only a single incision which is called a wrist band incision and with advanced instrumentation, we are able to take out the radial artery completely. The newer things that people are talking about now which everyone jumps to the conclusion that everyone can have it is robotic cardiac surgery. Now, it is very important to be for people to understand that it is a robotic assisted cardiac surgery and it is not a robotic bypass. So, what is the difference? Here, the robot is used only to harvest the mammary arteries from small separate incisions, but the actual bypass procedure, which is joining the artery to artery, is done through a small incision on the left side of the chest. So, that is not robotically assisted. That is a manual incision, which is done and the operation is done by the surgeon under direct vision. So, it is not advanced enough as yet to say that we have had a totally robotic surgery, but people like to say it. It is not necessarily true. And the number of patients who can have a minimally invasive cardiac bypass like this are not more than 10% of the patients who I see. 90% of them will still have a standard bypass. But, then what is the silver lining? When you do an angioplasty, the stents normally last about 10 years. Anything more than 10 years is a bonus, but 90% of the stents will have multiple blockages later on after the 10-year mark. And they will need a bypass at that time. With a bypass, normally if you look after yourselves well, the patients will survive for 25 to 30 years without needing an additional procedure. So, that is what is it is and current bypass techniques are all centered around this. I'd be happy to tell you that in Manipal, we do beating heart surgeries for almost all the patients with total arterial the way I have described it with very good results. Thank you.