Robotic-Assisted, Minimally Invasive Bypass Surgery at Emory

At Emory, we are constantly pushing the boundaries of modern medicine in an effort to discover safer, more effective ways of healing patients. At Emory Heart & Vascular, we’ve made remarkable strides in minimally invasive coronary artery bypass surgery (CABG) through the use of robotic technology.

Our minimally invasive CABG procedure utilizes a robotically assisted endoscopic technique, allowing the procedure to be performed with small incisions between the ribs, as opposed to opening the chest through splitting the breastbone (median sternotomy).

One of the many advantages of robotic-assisted CABG is that it doesn’t require the use of a heart-lung machine, or cardiopulmonary bypass, and can be performed without dividing the ribs or sternum. Therefore, the recovery from the procedure can be considerably shorter, and may be associated with a lower risk of some complications. Most patients are able to leave the hospital in as few as three days, and may return to normal activities in two-three weeks, as opposed to two-three months—the recovery time period generally associated with traditional CABG surgery.

Robotic-assisted CABG is most often performed on patients with single-vessel coronary artery disease. However, the procedure can be part of a hybrid approach for patients with multi-vessel disease. With a hybrid revascularization approach, surgeons work together with interventional cardiologists to combine the benefits of surgery with the benefits of stenting. Typically, the surgeon will perform a single-vessel robotic-assisted CABG for a blocked artery on the front of the heart, and cardiologists can perform a stenting procedure to the other blocked vessels.

Emory has been performing minimally invasive CABG since 2003, and is one of only a few medical facilities in the country offering the procedure.

Do you have questions about this or any other procedure at Emory Heart & Vascular? If so, please feel free to let me know here in the comments section.

About Michael E. Halkos, MD:

Joining the faculty in July 2009, Dr. Halkos received his MD and did his general and cardiothoracic surgical training as well as a two year research fellowship at Emory. He is currently Editor of the Resident Section of CTSNet and serves on the Executive Committee of the Thoracic Surgeons Residents Association. His clinical specialties include off-pump coronary artery bypass surgery, valve repair/replacement surgery, and minimally-invasive valve and coronary surgery, and his research interests are stroke after cardiac surgery and surgical outcomes.

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  • Mary M.

    My doctor has advised me of the necessity of one vessel by pass surgery. I already have two stents and the one in the major artery appears to be partially blocked. My doctor has told me about the minimally invasive surgery and I am considering this option rather than the “sandwich stent.” My main concern is how long must I take Plavix after the surgery? I have a severe reaction to this drug in that it destroys my taste buds and makes food so unpleasant to eat that I avoid food at almost any cost. What other options do I have? (Ticlid does the same thing to me)

    • Hey Mary,

      With a minimally invasive bypass procedure, surgeons use the left internal thoracic artery off of the chest wall to bypass the left anterior descending coronary artery, one of the main arteries in the heart. At Emory, this can be done through a small incision between the ribs without having to divide the ribs or the sternum. Although our patients are typically prescribed both plavix and aspirin, this is optional. Plavix is not necessary and does not have to be prescribed, especially for patients that have difficulty taking this medication.

      Hope this helps,

      Dr. Halkos

  • Frank D.

    Can you perform robotic bypass for a lower anterior descending artery? My doctor did a heart cath and I was diagnosed last year as having 40% blockage in my lower anterior descending artery. The cardiologist said the only way to tell if I have further blockage is to look for symptoms when they do a stress test which they just did. No symptoms but I do have a fairly constant dull ache in the center of my chest. I’m in my late 50’s. Is there advanced sensing technology that can detect how my heart disease is progressing? If I do eventually need a bypass, I believe robotic would be a better a standard open chest surgery or stint.

    • Dr. Halkos

      Hi Frank,

      While I can’t speak to your specific situation without seeing you in-person, I can give you some general information that should help out:

      Fortunately, the left anterior descending coronary artery is often the easiest artery to bypass with a minimally-invasive or robotic approach, because this artery lies on the front of the heart, right under the sternum. A bypass using an artery off of the chest wall, the left internal thoracic artery, remains the best treatment for significant disease in the proximal part of the left anterior descending coronary artery, better than stents or vein bypasses. At 40% however, there is no need to have surgery. A bypass to a 40% lesion is less likely to stay open because blood flow will preferentially go thru native artery, not the bypass. The gold standard to detect blocked arteries is a cardiac catheterization. In the cath lab, special tests such as intravascular ultrasound (IVUS) or fractional flow reserve (FFR) are very sensitive tests to assess the degree of blockage. Frequent follow up with your cardiologist with occasional stress tests is the current standard to follow patients with mild to moderate coronary artery disease. Optimal medical therapy, a proper diet and weight loss, and regular exercise are the most important keys for prevention.

      Hope this helps,

      Dr. Halkos