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What is MIDCAB?

MIDCAB is an acronym for "Minimally Invasive Direct Coronary Artery Bypass" which is a less invasive surgical approach for bypassing critically stenosed coronary arteries. It may also be referred to as "keyhole" heart surgery.

The MIDCAB approach is also performed "off-pump" and is most often used when one or two vessels need to be bypassed, typically on the front (anterior) side of the heart, such as the Left Anterior Descending (LAD) Artery.  With this technique, the surgeon enters the chest cavity through a small, 2-to-3 inch incision between the ribs (mini thoracotomy) on the patient's left side.  In most cases, the Left Internal Mammary Artery (LIMA) is used as the bypass conduit. IMPORTANT: Patients requiring more that one or two grafts are usually not candidates for MIDCAB because access to vessels on the back side of the heart is limited with this approach.

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As with OPCAB, MIDCAB grafting is performed without the use of the heart lung machine and without the use of a standard median sternotomy.

Typical MIDCAB methods involve grafting the left internal mammary artery to the left anterior descending artery through a small incision below the left breast. The technique can also be utilized for grafting the right internal mammary to the right coronary artery and the right gastroepiploic artery to the right posterior descending artery. For better access a hemi-sternotomy may be used.

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