He has only one reminder of his operation: a three-inch scar between two ribs on his right side. It doesn't look like much—the casual observer might guess that he had a run-in with a fence or a tree branch—but it's really a huge testament to the benefits of minimally invasive heart surgery, also known as beating heart surgery.
Kirschner was 30 when a routine stethoscope exam picked up strange sounds in his chest. A long-distance runner, kickboxer, skier, surfer (the list goes on), he had never had a hint of heart trouble. But an echocardiogram showed that his aortic valve had been deformed since birth, and now it was leaking. Suddenly the uberathlete had to face the prospect of heart surgery.
"My family and I decided to hold on as long as possible," Kirschner says. "We thought that maybe someday they'd be able to do the surgery without cutting my chest open."
By the time the leak grew too big to ignore, his plan turned out to be prophetic. Surgeons replaced his valve through a small incision in his side. Thin tubes equipped with tiny video cameras guided the surgeon's instruments.
Compared with the typical heart surgery patient, Kirschner had a lightning-fast recovery. "I was doing laps around the cardiac intensive care unit by the following day," he says. Two months after the operation, he says, he was "back to doing everything I used to do, and more. The only thing I had to give up is contact sports. No more kickboxing."
Minimally invasive surgery has become an increasingly popular option for all sorts of heart procedures, including bypass surgery. Unfortunately not all hospitals have the equipment or the staff to perform the procedures, and not all patients are eligible. Patients who have multiple blocked arteries or other complicated problems generally need traditional open-chest surgery. But for a patient needing a relatively simple procedure, minimally invasive techniques can repair the heart while minimizing recovery time.
Read below for a detailed explanation of minimally invasive bypass surgery. For a chart describing examples of people who may want to consider minimally invasive CABG surgery, and for another that lists some advantages and disadvantages of minimally invasive CABG surgery compared with traditional CABG surgery, visit our A-Z Health Library.
Standard coronary artery bypass graft (CABG) surgery is very successful in improving blood flow to the heart. However, the procedure is very invasive to your body for two major reasons:
Because of this level of invasiveness, the procedure can cause several complications. Surgeons have developed several new methods that minimize the invasiveness and risks involved with CABG surgery. But minimally invasive CABG surgery is not available everywhere. And minimally invasive CABG surgery is not right for everyone.
Beating-heart surgery
Beating-heart surgery is different from the standard CABG surgery. During a standard CABG procedure, your heart will be stopped and you will be connected to a heart-lung bypass machine. Beating-heart surgery (BHS) is unique because the procedure is performed without the heart-lung bypass machine while your heart is still beating.
There are two main types of beating-heart surgery, which is also called minimally invasive CABG surgery:
• Minimally invasive direct coronary artery bypass (MIDCAB)
• Off-pump coronary artery bypass (OPCAB)
MIDCAB
Minimally invasive direct coronary artery bypass (MIDCAB) surgery differs from traditional CABG surgery in two ways. First, the MIDCAB procedure does not use the heart-lung bypass machine. Second, your surgeon will cut several small incisions (thoracotomies) in your chest to access your coronary arteries instead of the one large incision (sternotomy) used in traditional CABG surgery. These smaller incisions expose only the sections of your arteries that require grafts, instead of your entire heart. As a result, you have a lower risk of infection. You also do not have the large scar associated with traditional CABG surgery.
The main disadvantage of MIDCAB is that it cannot be used to treat several diseased vessels, especially if arteries on both the left and right sides of the heart are blocked. The limited number of small incisions made using MIDCAB makes it difficult to treat more than two coronary arteries during the same surgery.
OPCAB
The off-pump coronary artery bypass (OPCAB) technique is another type of beating-heart surgery that requires the same large incision as traditional CABG surgery. OPCAB eliminates the use of a heart-lung bypass machine and may not require manipulation of the aorta.
The OPCAB procedure is performed basically the same way as traditional CABG surgery, except that the heart-lung bypass machine is not used and the aorta is not clamped.
Is minimally invasive CABG surgery right for you?
You and your doctor can discuss whether minimally invasive CABG surgery is appropriate for you. The decision depends on your overall health, the severity of your coronary artery disease, how many bypasses need to be created, and various other factors. If you choose to have the surgery, it is important to ask how experienced your cardiac surgeon is in doing these types of surgery.
- It involves making a large chest incision to expose your heart and arteries.
- It requires stopping your heart and connecting you to a heart-lung bypass machine that takes over the work of your heart and lungs.
Because of this level of invasiveness, the procedure can cause several complications. Surgeons have developed several new methods that minimize the invasiveness and risks involved with CABG surgery. But minimally invasive CABG surgery is not available everywhere. And minimally invasive CABG surgery is not right for everyone.
Beating-heart surgery
Beating-heart surgery is different from the standard CABG surgery. During a standard CABG procedure, your heart will be stopped and you will be connected to a heart-lung bypass machine. Beating-heart surgery (BHS) is unique because the procedure is performed without the heart-lung bypass machine while your heart is still beating.
There are two main types of beating-heart surgery, which is also called minimally invasive CABG surgery:
• Minimally invasive direct coronary artery bypass (MIDCAB)
• Off-pump coronary artery bypass (OPCAB)
MIDCAB
Minimally invasive direct coronary artery bypass (MIDCAB) surgery differs from traditional CABG surgery in two ways. First, the MIDCAB procedure does not use the heart-lung bypass machine. Second, your surgeon will cut several small incisions (thoracotomies) in your chest to access your coronary arteries instead of the one large incision (sternotomy) used in traditional CABG surgery. These smaller incisions expose only the sections of your arteries that require grafts, instead of your entire heart. As a result, you have a lower risk of infection. You also do not have the large scar associated with traditional CABG surgery.
The main disadvantage of MIDCAB is that it cannot be used to treat several diseased vessels, especially if arteries on both the left and right sides of the heart are blocked. The limited number of small incisions made using MIDCAB makes it difficult to treat more than two coronary arteries during the same surgery.
OPCAB
The off-pump coronary artery bypass (OPCAB) technique is another type of beating-heart surgery that requires the same large incision as traditional CABG surgery. OPCAB eliminates the use of a heart-lung bypass machine and may not require manipulation of the aorta.
The OPCAB procedure is performed basically the same way as traditional CABG surgery, except that the heart-lung bypass machine is not used and the aorta is not clamped.
Is minimally invasive CABG surgery right for you?
You and your doctor can discuss whether minimally invasive CABG surgery is appropriate for you. The decision depends on your overall health, the severity of your coronary artery disease, how many bypasses need to be created, and various other factors. If you choose to have the surgery, it is important to ask how experienced your cardiac surgeon is in doing these types of surgery.
Last Updated: January 8, 2008 
