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Coronary artery bypass surgery detours blood around blocked coronary arteries, enabling blood to flow to the heart and other organs. To accomplish this, a segment of a blood vessel is taken from another part of the body and is attached (grafted) to the aorta on one end. On the other end, the segment is grafted onto the coronary artery, bypassing the blockage.

Bloodless Cardiac Surgery

Using an advanced approach to cardiac surgery, NJCI minimizes the use of blood and blood products and for those who request it, NJCI attempts to avoid the use of transfusions completely. NJCI is one of the few centers in the region that routinely performs cardiac surgery often without the use of blood transfusions. Even complex procedures like coronary artery bypass grafts (CABG) and heart valve replacements are often done this "bloodless" way.

Minimally Invasive Surgery

For more than 30 years, coronary artery bypass graft (CABG) surgery has been saving lives. However, this procedure comes with certain risks. During this procedure, the heart is stopped for a number of hours while the patient is connected to a heart-lung machine (commonly referred to as the "pump") that takes over breathing and blood circulation. A surgeon makes a large incision (approximately 8-10 inches) down the middle of the chest and separates the breast-bone to provide clear access to the heart.

Because the heart is stopped for a number of hours during the CABG procedure, this procedure comes with certain risks. Possible complications related to this procedure are bleeding, stroke, renal failure, and neurological and cognitive problems. The average length of stay in the hospital is 5 to 7 days and patients have a recovery time of 4 to 5 weeks. But major medical advances in the way these surgeries are performed are lowering risks and offering less invasive alternatives.

NJCI lessens the trauma of this major procedure by offering two minimally invasive methods of bypass surgery: Minimally Invasive Direct Coronary Artery Bypass surgery and Off-Pump Coronary Artery Bypass surgery.

At NJCI, surgeons may use a minimally invasive approach by making smaller incisions. In some cases, this operation can be done on the heart while it is still beating. Patients may have quicker recovery times and fewer complications.

Minimally invasive surgery offers quicker recovery

Like the traditional CABG, minimally invasive surgery shunts blood around blocked arteries with grafted portions of other blood vessels. However, in minimally invasive procedures, a small incision is made between the ribs giving surgeons access to the heart. In some cases, a surgeon may choose to do minimally invasive surgery as an off-pump procedure, without the use of a heart-lung machine.

MIDCAB

Minimally Invasive Direct Coronary Artery Bypass surgery- Another alternative, minimally invasive direct coronary artery bypass surgery, uses a small incision, made between the ribs, to give the surgeon access to the heart. In some cases, a surgeon may choose to do minimally invasive surgery as an off-pump procedure as well.

While this surgery is highly effective, it is not for everyone since access for MIDCAB is limited to the front and left side of the heart. However, quicker recovery time makes it more attractive. Patients usually spend 3 to 5 days in the hospital and recover within 3 to 4 weeks.

Eligible patients usually have only one or two lesions in very specific areas, while patients who undergo the traditional CABG procedure may have up to 7 vessels bypassed at one time. However, each case is different, and patients should discuss all the options with their surgeon regarding what is right for them.

OPCAB

Off-Pump Coronary Artery Bypass surgery - Off-pump surgery is performed without use of the heart-lung machine. Using state-of-the-art mechanical devices, surgeons can isolate the area of the heart in need of repair, while still allowing the heart to beat normally. This type of surgery, when appropriate, allows surgeons the same broad access to vessels that a traditional CABG procedure provides, with fewer complications. Patients usually spend 4 to 6 days in the hospital and require a 4 to 5 week recovery time at home.

At NJCI, consultations with your surgeon to discuss treatment options are a key component to patient care. All surgical decisions are determined by a patient's specific and individual needs.

Radiofrequency Ablation

Radiofrequency ablation is a curative treatment used for treating many types of arrhythmias. An arrhythmia is essentially a misfiring of electrical impulses within the heart. Radiofrequency ablation is usually performed by threading electrode catheters, guided by fluoroscopy, into the cavities of the heart and delivering radiofrequency energy to a precise spot where the troublesome tissue is located thereby permanently destroying it.

	The da Vinci Console.
	The robotic arm mimics a surgeon's hands but with greater precision.

Now, radiofrequency, microwave, and laser ablation is being used in surgery, but instead of being threaded via catheter, the surgeon knows the electrical pathways and isolates the electrical conduction paths that cause the atrial arrhythmias. Surgical use of radiofrequency, microwave, and laser ablation is particularly useful for patients with mitral valve problems when in atrial fibrillation - a type of arrhythmia that is difficult to treat with the catheter method.

Robotic Surgery

The da Vinci system, designed by Intuitive Surgical, allows the surgeon to sit at a computer control console about 10 feet away from the patient. Technically, the device is not a robot, because its arms are operated in real time by the surgeon. The surgeon's fingers are placed in Velcro rings and connected to master controller. When the surgeon's fingers move, the robot arms move. Another arm is used to operate a 3-D camera.

The da Vinci system offers greater precision – surgeons are able to use tiny holes to access the chest cavity, instead of large incisions, which leaves smaller scars and allows for a shorter recovery time.

While it is not yet approved by the FDA for coronary artery bypass surgery, da Vinci can be used for mitral-valve replacement surgery and for harvesting of the internal mammory artery, crucial to many bypass surgeries.

Valve Replacements

Heart Valves help regulate the flow of blood through the heart. If there is damage to the valves, the heart may not be able to pump properly. Valve replacement surgery can be done with either artificial valves or living tissue valves.

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