Surgeon Farzad Najam grafts a blood vessel (shown to the top right of the picture) during a coronary artery bypass using the daVinci robot.
 
Coronary Artery Bypass Surgery Using the da Vinci® Surgical System
 
Many patients with heart disease have critical blockages in the arteries that supply blood to the heart. Coronary artery bypass surgery is a proven technique, with excellent long-term results, to help patients with such a condition.

Surgeons at GW Hospital use advanced surgical techniques to perform bypass surgery, including newer minimally invasive techniques, and now the da Vinci robot. This means smaller incisions, less prominent scars, less pain and faster recovery for patients.
 
When is coronary artery bypass surgery recommended?
 
In general, bypass surgery is recommended when:

1. The main heart artery is significantly narrowed.
2. All three of the arteries in the heart are blocked or have reduced blood flow.
3. The blocked arteries can’t be treated with angioplasty or stenting.
4. The heart function is reduced significantly due to blockages, and bypass surgery improves survival in such patients.

Bypass surgery often relieves symptoms of chest pain, called angina, improves exercise performance and reduces the risk of a heart attack.

Discuss with your doctor whether your coronary artery bypass can be performed using a minimally invasive technique. The decision depends on your overall health, the severity of your coronary artery disease, how many bypasses need to be created and various other factors.
 
“Traditional” Coronary Artery Bypass Surgery

When performing traditional bypass surgery, the surgeon makes a six- to ten-inch surgical incision down the center of the chest, separating the breastbone to reach the heart. Surgeons remove a healthy blood vessel from the patient’s arm or leg. An artery from under the patient’s chest wall also is harvested. These blood vessels are grafted onto the affected vessel in the heart to reroute blood flow around the blockage and restore blood flow to the heart muscle. Traditionally, the patient is connected to a heart-lung bypass machine that continues to pump blood throughout the body during the procedure. Coronary artery bypass surgery can be performed “off pump” – or on a beating-heart. In this case, a section of the heart is immobilized with specially designed stabilizers while the rest of the heart continues beating normally throughout the bypass procedure.
 
Minimally Invasive Coronary Artery Bypass Grafting (CABG) using the daVinci Robot
 
Minimally invasive coronary artery bypass grafting using the da Vinci robot is performed while the heart is beating, without using a heart-lung machine. This procedure can be performed for patients who have one or more blocked arteries.

During the procedure, the surgeon makes a series of three small incisions (for ports through which instruments are inserted) in the chest through which the robotic arms are inserted. In addition, a separate two- to three-inch incision is made in the chest directly over the artery or arteries to be bypassed.

The robotic arms are inserted through the ports – two of the arms hold surgical instruments and the third is a tiny video camera. The surgeon then sits at a computer console, about ten feet from the operating table, and the camera transmits a three-dimensional magnified image from inside of the patient’s chest. The surgeon places his/her hands in holders that control the robotic arms and performs the procedure while seated at the computer console.

Using the da Vinci robot to mobilize the artery from under the patient’s chest, the surgeon then makes a two-to-three-inch incision to bypass the blocked artery/arteries. The blood is rerouted through the newly-grafted artery, bypassing the blocked or narrowed artery and increasing blood flow to the heart.
 
Benefits to Patients
 
By using the da Vinci robot, surgeons eliminate the need for the six- to ten-inch surgical incision and the practice of spreading apart the patient's breast bone, in order to gain access to the heart. This reduces surgical trauma and may lead to a number of benefits for patients:

• Less pain and less risk of infection
• Reduced use of postoperative analgesia
• Shorter hospital stays and faster returns to normal activities
• Decreased inflammation of body tissue
• Less bleeding and fewer units of blood for transfusion
• Decreased risk of complications associated with heart-lung bypass machine (such as stroke)
• Less scarring
• Faster recovery