Robotically Assisted Coronary Bypass Graft (CABG) Surgery

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Faisal Bakaeen, MD:

Hello. My name is Faisal Bakaeen. I'm professor of Cardiothoracic Surgery at the Cleveland Clinic and the surgical director of the Coronary Center.

Tarek Malas, MD:

Hi. My name is Tarek Malas. I'm a cardiac surgeon here at the Cleveland Clinic. I'm a robotic surgeon here as well.

Faisal Bakaeen, MD:

As a background, coronary artery bypass surgery started here at the clinic back in 1967 with Dr. Favaloro from Cardiac Surgery and Dr. Mason Sones from Cardiology. That was really the first heart team, and they established coronary artery bypass surgery as a standard of care where they published the largest series demonstrating the effectiveness and safety and durability of coronary artery bypass surgery. And over the years, the Cleveland Clinic has innovated with coronary artery bypass surgery with using arterial grafts, namely bilateral internal thoracic arteries, and those are the arteries from the chest that are known to have a unique biology and have excellent patency. And also the clinic has done complex and high risk cases and became internationally renowned for taking on referrals where patients were told they have limited or no options.

Despite the complexity, acuity and risk of all those cases, the outcomes have been exceptional at the Cleveland Clinic. The mortality for bypass surgery, despite the emergencies and the complexities, has been consistently around five in a thousand for many years now.

Now, we emphasize immediate outcomes, but we also emphasize long-term outcomes. I've mentioned that we use multiple arterial grafting, and those arteries stay open for a long time, and that translates to improved patient survival. But we also look at the patient's preferences, and we try to minimize the extent and the invasiveness of the surgery based on the anatomy of the patient and the patient's preference. One such approach is to do the bypass surgery through a limited mini left-sided incision between the ribs, better known as MIDCAB, and this can also be performed with the assistance of the robot.

Tarek Malas, MD:

So we have a vast experience in robotic surgery here at the Cleveland Clinic. The robot is just a tool that we use in the operation. We can do a minimally invasive coronary artery bypass graft surgery using a robot if we think that you're a candidate for that, and we usually do a CT scan and we evaluate you to see if you're a candidate. The robot is a fantastic tool to be able to perform this in a much smaller incision than the traditional open heart coronary bypass surgery or CABG surgery. So what we do in a robot is instead of cutting open the breastbone to do the traditional bypass surgery, we go through the chest through the left side, and what we do is we insert these three tubes that go into the chest, and these are robotic tubes. Basically, these are three robot arms that have a very high magnification camera and two working arms.

And this allows us to take down the mammary artery that Dr. Bakaeen was referring to in a much less invasive way and that is less traumatic. And what we do is we take that artery down and then we use that artery to bypass the artery that's blocked on the heart, and we can do this all through the left chest. If we do this through a robotic incision, the incisions are much smaller. We don't cut any bones, we just go through in between the ribs, and finally, we do the surgery through a small incision right here at the front in between the ribs as well.

What does that mean if we're able to do this robotically? Number one, improved result of leaving the hospital, so your length of stay in the hospital will be much faster. What does that mean for patients? It means your recovery back to your normal life will be faster. You'll be able to go back to your job, to your activities in a much faster timeframe than if you have a traditional open heart surgery where we cut the bone, the sternum. It also means that the incision is better cosmesis for the actual incision and it has a much less chance of also getting infected. So it does have its benefits to do robotic surgery if you are a candidate as well.

Faisal Bakaeen, MD:

If you or your loved ones have coronary artery disease, consider receiving care at the Cleveland Clinic. Cleveland Clinic is made up of a multidisciplinary team that's ready to take care of you and your family from A to Z, from prevention of coronary artery disease to treatment. Multiple treatment modalities exist from stenting to less invasive surgery, including robotic surgery. And given the excellent outcomes and the durability of such treatments at the Cleveland Clinic, that would be something that you should keep in mind. We look forward to meeting you and taking care of you at the clinic. Please don't hesitate to contact us if we could be of any help, anytime. Thank you very much.

Announcer:

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