Mount Sinai Heart recently became the first in New York to offer a minimally-invasive type of heart bypass surgery.
The procedure, which is called totally endoscopic coronary arterial bypass surgery (TECAB), is performed using Intuitive Surgical's da Vinci Surgical System and Cardica's C-Port Flex-A. Surgeons make four one-centimeter-long incisions and maneuver the robotic instruments inside to harvest the mammary artery.
A specialized automatic device is then use to connect the mammary artery to the coronary artery on the front wall of the heart and 13 small stainless steel clips are placed to hold the arteries together.
During the conventional heart bypass procedure, surgeons have to open the patient’s chest and sew the arteries together by hand. Since the incision can be up to 12 inches long, patients have to remain in the hospital for seven to 10 days and can’t resume their normal activities for up to three months.
Patients who undergo TECAB are able to leave the hospital one to four days following surgery, and can resume their normal daily activities after one to two weeks. This is especially beneficial for patients who are not ideal candidates for conventional open-chest bypass.
Patients with a limited amount of blockages on the left side of their heart are the best candidates for TECAB. However, those who underwent heart surgery or were exposed to radiation therapy near the chest in the past are not able to receive TECAB.
TECAB offers patients a faster recovery, lower risk of infection and less pain and scarring, but the downside is that it’s very challenging for surgeons to perform. Only a few bypass surgeons around the globe have the skill and training required to perform it.
“The procedure is very technically demanding and requires proficiency in off-pump coronary surgery as well as robotic surgery," Dr. Gianluca Torregrossa, one of the surgeons who performed the procedure at Mount Sinai, told HCB News. "That makes it feasible by highly-skilled teams."
Dr. John Puskas, who performed the procedure alongside Torregrossa, believes that TECAB could eventually become the standard of care for coronary artery disease. But he added that more surgeons would have to learn how to do it for that to happen.
“Technology though is improving, making this operation easier,” said Torregrossa. “We are expecting, in the near future, the introduction in the market of major innovation that could lead to adoption of [this] technique.”