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Published on July 11, 2017

MICS hybrid heart surgeries offer patients more options

Gundersen Health System cardiothoracic surgeon Prem Rabindra, MD, FACS, is a pioneer in the use of minimally invasive coronary surgery (MICS). He began performing MICS at Gundersen in 2009 and since then he has performed more than 400 MICS procedures. He was among the first in this country to use the procedure for coronary artery bypass grafting (CABG) and is still among an elite group of cardiothoracic surgeons to perform MICS-CABG on multiple vessels.

Prem Rabindra, MD, FACS

Prem Rabindra, MD, FACS, Gundersen Heart Institute

Dr. Rabindra is also among the few offering hybrid MICS procedures such as:

  • MICS-CABG in the same procedure as another heart procedure, such as mitral valve repair, through bilateral mini-thoracotomies
  • CABG in conjunction with a percutaneous coronary intervention (PCI), such as angioplasty with stent, on a different area of the heart

"Patients often ask, 'If you are unable to perform my surgery through the minimally invasive approach can you still open my chest to complete the surgery,'" Dr. Rabindra shares. "I tell them, Yes, but we don't have to. We can make a small incision in the groin and use the femoral artery to hook up the heart/lung machine. We still don't need to stop the heart, but the pump is taking over circulation. By reducing the volume of blood in the heart, it gives us more room to complete the MICS. We've had to use this approach in less than 10 percent of patients."

According to Dr. Rabindra, "I often work in collaboration with my colleagues in cardiology or consult with the Heart Team, which is made up of cardiologists and cardiothoracic surgeons. Together we can address multiple heart problems using different modalities. This is particularly important for patients with complex medical conditions. We can generally offer less invasive treatments, avoiding a sternotomy, or if a patient doesn't qualify for surgery we may be able to offer PCI instead."

While there are advantages to MICS, it is not right for every patient. On the flip-side, you may have a patient who is a candidate for MICS—especially when multiple vessels are involved—who may have been turned down or at high risk for traditional surgery. Because surgery and recovery from MICS is less stressful on the body, MICS may be a viable alternative for these patients.

An appointment for your patient can usually be arranged in one to three work days. We'll work with you to get the necessary medical records and the results of tests your patient may have already had.

Dr. Rabindra has had patients come from as far as away as Alaska, Georgia and South America to have MICS performed at Gundersen. We understand that it can be difficult for a patient with heart disease to travel, especially long distances. So when necessary, we make every effort to arrange for the consultation/evaluation appointment followed by surgery (if appropriate) the next day.

If your patient has surgery at Gundersen in La Crosse, follow-up care can be done by you and cardiac rehab at a facility close to your patient's home.

If you have a patient who might benefit from MICS-CABG or a MICS hybrid procedure, consider a referral appointment for an evaluation or second opinion. You can also contact Dr. Rabindra for a consultation. Call via MedLink at (800) 336-5465 or (608) 775-5465.

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