What is Coronary Artery Disease?
Coronary artery disease or coronary heart disease is the number one cause of death in the USA and it affects more than 13 million Americans at present. It is a condition where atherosclerosis of the arteries in the heart leads to heart attack, heart failure and death. This means that fat deposits from bad cholesterol cause stiffness within the small arteries supplying oxygen to the heart muscles. With less blood and oxygen supply to the heart irregular heartbeats (arrhythmias) and tissue damage (infarcts) ensue, causing weakening and eventual failure of the heart to pump blood to the circulation.
Treatment of Coronary Artery Disease
The goals of therapy for coronary artery disease are to reduce fat deposition and constriction of the heart vessels. Improvement of lifestyle, consisting of diet, exercise and avoidance of smoking and alcohol are basic to therapy. In addition, medications are indicated for decreasing cholesterol levels and treating concomitant conditions such as diabetes, hypertension and other diseases.
When the individual is at risk for an imminent heart attack or heart failure surgical intervention may also be indicated. These procedures include angioplasty and coronary artery bypass surgery.
Angioplasty involves inserting a balloon with a catheter to the coronary artery to widen or dilate it resulting in improvement of circulation. If this is not enough to prevent a heart attack an open chest procedure to replace a blocked artery with another artery or vein may be done, called coronary artery bypass grafting (CABG). The blood vessel used to replace the diseased artery is taken from another part of the body such as the leg or chest wall, which undergoes a separate open surgical procedure.
The latest advances in computer and robotics engineering, however, offer a less invasive approach to this type of treatment in the form of endoscopic coronary artery bypass surgery.
Totally Endoscopic Coronary Artery Bypass Surgery (TECAB)
TECAB is done under general anesthesia. Connection to a heart-lung bypass machine is not necessary during the operation, although for CABG it is mandatory.
Compared to CABG, where the chest is split wide open through the breast bone, TECAB is done using four to five small (fingertip-sized) slits on the chest. Endoscopy is done by inserting a tiny camera into the slits and this provides the cardiovascular surgeon a three dimensional view of the heart anatomy by projecting the images in an external monitor.
A surgical robotic device assists the surgeon by inserting small and thin instruments to reach into the heart without opening the chest wall. The blood vessels to be used for grafting are likewise harvested from the chest using this device. The precision and maneuverability with the robotic arms provides great advantage to the procedure compared to the manual job done by a heart surgeon. Suturing on tiny blood vessels is aided by telescopic devices that improve results in terms of accuracy.
Advantages of TECAB
Since TECAB uses minimally invasive but accurate technology, the advantages are easy to comprehend:
- Less blood loss and likelihood of blood transfusion
- Reduced risk for infection
- Less post-operative pain due to minimum surgical trauma
- Fewer complications associated with the use of a heart-lung bypass machine
- Shorter hospital stay
- Less likelihood of scarring compared to an open chest procedure
- For elderly people who are prone to osteoporosis, complications with weakened bones are avoided
Risks and Disadvantages of TECAB
Endoscopic and robotic technologies need higher levels of training and experience. Expertise and technological training are also demanded from the whole team of surgeons, physicians, nurses and lab technicians. Hospitals must be ready to provide such services. For these reasons very few cardiovascular surgeons can perform TECAB.
In addition, not all patients with coronary heart disease are candidates for this kind of procedure. Endoscopic coronary artery bypass surgery is not suitable for patients who are extremely obese, those who have unstable blood pressure, those with an acute heart attack and patients who have had previous chest surgery with tissue adhesions.
The general risks for the procedure, even if minimal, are similar to those for general anesthesia and other types of surgeries, and these include bleeding, pain, infection and difficulty in breathing. Furthermore, risk factors also include the patient’s age and other medical conditions that can predispose him to complications.
The University of Chicago Medical Center, "Totally Endoscopic Coronary Artery Bypass (TECAB) Surgery" accessed 1/20/11
University of Maryland Medical Center, “Minimally Invasive Coronary Bypass Surgery” accessed 1/20/11