What is Minimally Invasive Direct Coronary Artery Bypass Graft (MIDCAB)

A coronary artery bypass graft (CABG) is a procedure to improve blood flow to the heart. During this procedure, a section of a blood vessel (graft) is taken from another part of the body and connected to a blocked artery that leads to the heart (coronary arteries). The graft is placed so that blood flows around (bypasses) the blocked part of the coronary artery and directly to the heart.

A minimally invasive direct coronary artery bypass graft (MIDCAB) is done through a small incision in the chest. It is usually done to treat blocked arteries in front of the heart. MIDCAB does not require the use of the heart-lung machine.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any medical conditions you have.
• Any surgeries you have had.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Pain.
• Stroke or heart attack.
• Short-term memory loss or confusion.
• Failure of the graft to work properly, or the graft becoming blocked.
• Damage to the lung, chest wall, heart, or nerves.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

Testing

You may have tests done, including:

• Blood tests.
• Imaging tests, such as a chest X-ray.
• A test to check your heart’s electrical activity (electrocardiogram).
• A test that takes a picture of your heart using sound waves (echocardiogram). This test checks for abnormalities in the heart.
• A test that uses dye and X-ray or CT scan to check blood flow in your heart (coronary angiogram).

General instructions

• Pack clothing for recovery. Bring loose-fitting clothing, pants with an elastic waist, and comfortable, non-skid shoes that are easy to put on.
• For 3–6 weeks before the procedure, do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. Quitting smoking is one of the best things you can do for your heart health. If you need help quitting, ask your health care provider.
• Ask your health care provider what steps will be taken to prevent infection. These may include:
  • Removing hair at the surgery site.
  • Washing skin with a germ-killing soap.
  • Taking antibiotic medicine.

What happens during the procedure?

• An IV will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• A small, thin tube (catheter) may be placed in your urethra to drain your urine during the procedure.
• The left lung will be collapsed to allow access to the heart. A special breathing tube will be used to ventilate the right lung.
• An incision will be made on the left side of your chest, above the artery that needs to be bypassed.
• A tool will be used to spread open your tissues and allow access to the artery (retractor).
• A section of a healthy blood vessel will be removed from another part of your body, usually in the chest. This will be the graft.
• One end of the graft will be attached to the coronary artery below the blockage with stitches (sutures). The other end will be attached to the heart in order to allow blood to bypass the blockage.
• Your incision will be closed with sutures.
• Tubes may be placed in your chest to help drain excess fluid (drainage tubes). These will be removed before you leave the hospital.
• Your incision will be covered with a bandage (dressing).

This procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital or clinic.
• You may recover in the intensive care unit (ICU) at first. After that, you will be moved to a regular recovery area.
• You may have a temporary pacemaker while in the ICU. This is a machine that helps regulate your heartbeat.
• You may continue to have:
  • An IV giving you fluids and medicines.
  • A catheter draining your urine.
  • Drainage tubes in your chest.
    • These tubes are usually removed the day after the procedure.
• You may be given oxygen through a face mask or tubes in your nose (nasal cannula).

Summary

• A coronary artery bypass graft (CABG) is a procedure to improve blood flow to the heart.
• A minimally invasive direct coronary artery bypass graft is done through a small incision in the chest and without the use of the heart-lung machine.
• Pack clothing for recovery. Bring loose-fitting clothing, pants with an elastic waist, and comfortable, non-skid shoes that are easy to put on.

Minimally Invasive Direct Coronary Artery Bypass Graft, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain and swelling around your incision.
• Fatigue.
• Muscle pain in the shoulders and back.
• Problems sleeping.
• Loss of appetite.
• Constipation.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• Wear a medical alert bracelet or carry a card that lists what medicines you take.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • Redness.
  • More pain or swelling.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Eating and drinking

• Eat a heart-healthy diet. This includes plenty of fruits and vegetables, lean meats, whole grains, and low-fat or fat-free dairy products. Avoid foods that are high in salt (sodium), sugar, saturated fat, or trans fat.
• Limit alcohol intake to no more than 1 drink a day for nonpregnant women and 2 drinks a day for men. One drink equals 12 oz of beer (355 mL), 5 oz of wine (148 mL), or 1½ oz of hard liquor (44 mL).

Activity

• Rest as told by your health care provider.
  • Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. This is important to improve blood flow and breathing. Ask for help if you feel weak or unsteady.
  • Gradually increase your activity level. Ask your health care provider what activities are safe for you.
• Participate in cardiac rehabilitation. This is a program that includes exercise training, education, and counseling to help you recover from surgery.
• Stop any activity right away if you have chest pain, shortness of breath, irregular heartbeats, or dizziness.
• Do not engage in sexual activity until your health care provider approves.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.

Lifestyle

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Maintain a healthy weight. Ask your health care provider what a healthy weight is for you.

Driving

• Do not drive until your health care provider approves.
• Do not drive or use heavy machinery while taking prescription pain medicine.

General instructions

• Wear compression stockings as told by your health care provider. These stockings help prevent blood clots and reduce swelling in your legs.
• Drink enough fluid to keep your urine pale yellow.
• Weigh yourself every day and write it down. Sudden weight gain may be a sign that your body is holding (retaining) fluid that may make your heart and lungs work harder.
• Take 2–3 deep breaths every few hours during the day while you recover. This helps prevent complications like pneumonia.
• Think about attending individual or group therapy sessions while you recover. This can help ease some of your fears or anxieties after surgery. Therapy may be a part of your cardiac rehab program.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• Your incision shows signs of infection, such as:
  • Redness.
  • More pain or swelling.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• You have swelling in your ankles or legs.
• You have pain in your legs.
• You gain 2 lb (0.9 kg) or more in one day.
• You have nausea or you vomit.
• You have diarrhea.
• You have memory problems or confusion.

Get help right away if:

• You have severe chest pain that spreads to your jaw or arms.
• You have shortness of breath.
• You have a fast or irregular heartbeat.
• You have numbness or weakness in your arms or legs.
• You feel dizzy or light-headed.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. Gradually increase your activity level as directed.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.