may edition file

case reports
ROBOTIC BYPASS
A unique case where the least invasive option of minimally invasive
cardiac surgery is employed
Mrs Malliga, a 63-year old lady from Ambattur in
Chennai, had been suffering from chest pain for the
past six months. As her condition worsened and
the chest pains increased, she was brought to
Apollo Hospital Chennai, where she consulted with Dr.
Mohammed M Yusuf, a cardiothoracic surgeon specializing
in Minimally Invasive Cardiac Surgery and Dr Damodharan,
Senior Consultant Cardiologist. Mrs Malliga complained of
chest pain on minimal exertion. Her case history
showed that she was diabetic and had slightly higher
cholesterol levels than normal, two high-risk factors for
heart disease.
An angiography revealed blocks in three major arteries
that supply blood to the heart. Typically in such cases, an
open-heart bypass surgery or stents would be indicated.
Keeping the history of diabetes and cholesterol in mind, an
open-heart bypass surgery was deemed the best treatment
option. This procedure involves using a healthy blood vessel
from another part of the body to allow blood to bypass the
block in the vessel. For blocks in the left anterior descending
artery, a healthy artery from the chest wall itself is preferred.
However, for other less important arteries, surgeons may use
veins from the leg as well.
“A bypass surgery is more effective for blocks in the
major arteries, compared with stents. The majority of stents
are beneficial for up to 5-10 years, after which blocks may
reappear”, says Dr Yusuf. While the treatment outcome is
excellent and mortality rates are extremely low in bypass
surgeries, the procedure involves making a 6-8 inch long
incision in the chest and cutting through the breastbone to
access the heart, resulting in a considerably long recovery
period that can last up to 4 months.
Recent advances in open-heart surgery techniques
include minimally invasive approaches that require smaller
incisions and offer faster recovery periods. Instead of the
large 6-8 inch incision for the conventional bypass surgery, a
smaller cut in the chest is sufficient for a minimally invasive
procedure. This reduces morbidity and brings the recovery
time to 2 weeks. Dr Yusuf and his medical team have been
performing minimally invasive bypass surgeries for over a
year with excellent results.
More recently, robotic assistance to perform the
procedure has gained interest. Dr Yusuf and his team opted
to conduct this minimally invasive operation using robotic
assistance rather than the conventional
approach. Two of the three major blood
vessels of the patient were severely blocked
and required bypass surgery. The blocks
in other vessels could be treated with
angiography stent insertion. Dr Yusuf’s
team, therefore, decided on a 2-step
approach. Under the guidance of Dr Frank
Vanpraet, Director of Robotic and Minimally
Invasive Cardiac Surgery, OLV Hospital, Aalst,
Belgium, Dr Yusuf performed the minimally
invasive coronary artery bypass grafting
surgery using robotic assistance. In the
ROBOT-ASSISTED MINIMALLY
INVASIVE CORONARY ARTERY
BYPASS TECHNIQUE LOWERS
THE RISK OF COMPLICATIONS
SUCH AS STROKE, EXCESSIVE
BLOOD LOSS, AND INFECTION
second step, two days after the first
surgery, Dr Damodharan performed
angiography and drug-eluting stent insertion
for the remaining blocks in Mrs Malliga’s
coronary arteries. This was done with the
assistance of a specialized intravascular
ultrasound.
Robot-assisted minimally invasive
coronary artery bypass grafting has several
advantages, as it is the least invasive
option among minimally invasive cardiac
surgeries. This technique lowers the risk
of complications such as stroke, excessive
blood loss, and infection. Patients also
have reduced pain, smaller scars and
faster recovery periods and it is ideal
for multivessel blocks. “Even though it is
more expensive than conventional bypass
40 / FUTURE MEDICINE / May 2019