Heart

Learn more about MICS-CABG, and its benefits for your patients, during a live interactive web chat with Gundersen Health System cardiothoracic surgeon Prem Rabindranauth, MD, FACS. This webcast is now complete, but the archived version is available here.

Your patients may be able to avoid the sternotomy that’s been used for decades to open the chest during coronary bypass surgery.

Gundersen Heart Institute, in La Crosse, Wis., is a leader in minimally invasive coronary surgery for coronary artery bypass grafting (MICS-CABG). Gundersen performs up to quadruple bypass using the mini-invasive technique. Most other heart centers either don’t do MICS or perform single bypass using this technique. The nearest center to La Crosse that routinely performs complete heart revascularization using MICS is in Chicago.

Benefits of MICS-CABG include: less pain, no broken bones and a quicker recovery. Patients are back to normal, everyday activities in as little as two weeks post surgery.



Fifty-four-year-old Mike Jorgenson has been a member of the La Crosse Fire Department for the past 32 years. His family and fellow firefighters know there is very little that will stop him in his tracks.

 
  Mike Jorgenson ran the bases with his heart surgery team at a La Crosse Loggers game. Thanks to minimally invasive coronary surgery, Mike was able to get back in the game sooner.
But on June 6, Mike knew something wasn’t quite right. He hadn’t been sleeping well and experienced difficulty breathing. He initially thought it was a reaction to the food he had eaten the night before. But when his shortness of breath continued to worsen, Mike asked his wife, Pennie, to take him to Gundersen Health System’s Trauma & Emergency Center.

There, doctors performed a chest X-ray and CAT scan. Further testing, including an echocardiogram and heart catheterization, revealed he had three blockages in his heart. At just 54 years of age, this diagnosis, alone, was enough to take Mike's breath away. Gundersen cardiothoracic surgeon, Dr. Prem Rabindra, said Mike would need major heart surgery to repair the blockages. That would mean time away from work and many weeks dedicated to cardiac rehabilitation.

Ironically, just a few weeks earlier, Mike heard about Gundersen's new minimally invasive coronary surgery in which multiple bypasses can be performed through one small incision, with no need to 'crack the chest.' He joked with his colleagues saying, "If I ever need heart surgery, that's the way I'd go!" Mike was relieved to hear from Dr. Rabindra that he was a good fit for this surgery.

Mike spent just four days in the hospital following a successful surgery. Through cardiac rehab at Gundersen and his efforts at home, Mike continues to show progress and grows stronger every day. At one point, Dr. Rabindra had to remind him to slow down—not something you'd expect to hear right after major heart surgery.

"We are fortunate, here in the Coulee Region, to be one of only a handful of places in the country where you can have minimally invasive heart surgery," says Mike. And he can't say enough about the Gundersen staff. "Everyone, including Dr. Rabindra and his surgical team, the exercise physiologists, nurses and housekeeping staff, were incredibly polite and sincere. I couldn't have asked for a more dedicated team."
Some patients needing mitral valve repair/replacement or coronary artery bypass grafting (CABG) may be able to avoid having the sternotomy that’s historically been used to open the chest during heart surgery. Gundersen cardiothoracic surgeon Prem Rabindranauth, MD, is using a minimally invasive approach for some mitral valve and CABG procedures.

“Rather than opening the chest fully, the minimally invasive technique allows us perform the procedure through a small incision. The surgical repair itself is exactly the same. The revascularization is just done through a smaller incision,” explains Dr. Rabindranauth, who is known as Dr. Rabindra.

Minimally invasive mitral valve surgeries are done through a small incision in the right chest, while minimally invasive CABG, also known as MICS CABG, is performed through a small incision in the left chest. One or two other small working port incisions are also needed for chest tubes, just as they would be with a traditional sternotomy.

“We always get the question, ‘How are you able to perform these surgeries through a small incision?’ I actually thought the same thing when I first heard about minimally invasive heart surgeries, but it is possible. The newer retractors and minimally  invasive instruments allow us to access the coronary arteries and aorta very well, and it’s as safe and effective as traditional surgery,” Dr. Rabindra assures.

Dr. Rabindra has been performing minimally invasive mitral valve surgeries for years. The MICS CABG is a newer procedure and has been used at Gundersen since December 2009. In that time, Dr. Rabindra and physician assistant Todd Vessey, PA-C, have seen the advantages for patients.

“Our patients seem to turn around faster after minimally invasive surgery than after traditional surgery. Because we don’t have to worry about the sternum healing, our minimally invasive surgery patients have fewer restrictions and are able to increase their activity levels quicker than those who have traditional surgery,” Vessey comments.

Despite the advantages, it is not an appropriate approach to coronary surgery for every patient. “For those who are having mitral valve surgery, the minimally invasive approach can be used for sole mitral valve, tricuspid or double valve (mitral valve and tricuspid) repairs or replacements. However, we can’t do a bypass at the same time as the valve repair or replacement because the bypass can’t be done through an incision on the right side. We also can’t access the aortic valve through the right-side incision,” Dr. Rabindra explains.

When it comes to MICS CABG, the patient’s size and coronary anatomy are used to decide who is a good candidate for the minimally invasive approach.

“If you think you may have a patient who is appropriate for a minimally invasive heart surgery, please don’t hesitate to call us. We’re always happy to evaluate your patient,” Dr. Rabindra says.

For more information for your patients, visit the Heart website. For a consultation, contact Dr. Rabindra via MedLink.
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