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MICS CABG Minimally Invasive Cardiac Surgery Coronary Artery Bypass Graft

CABG Surgery: Standard of Care. Invasive cardiac surgery is not a first-line treatment for patients where less invasive options, such as angioplasty and stenting, are feasible. Nevertheless, for many patients with advanced or diffuse disease, surgery remains the best option. Current research suggests that chronic total occlusions, patients with left main disease, diabetics and those with diffuse multi-vessel disease are best served by surgical intervention.When the left internal mammary artery15

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MICS CABG Minimally Invasive Cardiac Surgery Coronary Artery Bypass Graft

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    1. MICS CABG Minimally Invasive Cardiac Surgery – Coronary Artery Bypass Graft

    3. MICS CABG: Overview What is a MICS CABG Procedure? Off-Pump CABG in which the anastomoses as well as the LIMA takedown are performed under direct vision through a lateral mini thoracotomy. At times, certain patients may require a pump-assisted beating heart approach or a hybrid procedure (staged with a PCI).

    4. I’ve seen this all before… MICS is not MIDCAB…disadvantages of MIDCAB Poor early results in the mid- late 90’s Rib-spreading, partial removal of the front rib as well as the parasternal incision is very painful to patients Primarily for single vessel disease – (LIMA-LAD) Less access to harvest the length of the LIMA Poor target visibility and access due to medial incision

    5. Advantages of MICS CABG vs. MIDCAB Access to the entire length of the LIMA Ideal access to anterior (LAD/ Diag) and lateral vessels (OM/ Circ) PDA is accessible in the majority of cases Superior cosmetic results Not robot dependant Complete revascularization is achievable almost always

    6. MICS Incisions

    7. MICS Instruments

    8. LIMA Harvest and Access to Aorta*

    11. Sternotomy vs. MICS

    12. Minimally Invasive Coronary Artery Bypass Grafting: Dual Center Experience in 450 Consecutive Patients American Heart Association – CIRCULATION 2009 N = 450 Mean Age 63.2 Female 32% Diabetes Miletus – 34% PCI 23%

    13. MICS CABG Experience: Mortality: 1.1% vs. 2.1 (NYS) Conversions: 12 (2.7%) Pump Assist: 3.8% Hybrids: <2% AFIB: 17% vs. 21% STS 2008 Return for Bleeding: <1% Deep Infection/Dihiscenence: 0% vs. .04% STS 2008 Median Length of Stay: 4 Days Known Graft Failures: 10 Patients (3%) at mean follow-up of 19.2 Months

    14. Conclusions: MICS CABG is feasible and safe Excellent procedural and short term outcomes Quick recovery and minimal pain All ready gaining wide acceptance: - Direct Vision - Flexible Graft Strategy - Aortic Proximal - In Synch with Current Available Technology

    15. Patient Selection/Inclusion Criteria* Coronary Anatomy Left main coronary artery disease (CAD) with normal right coronary artery (RCA) Triple vessel disease with medium to large posterior descending artery (PDA) Complex proximal left sided lesions with or without large branch involvement Previous unsuccessful stenting Co-Morbidities: Long-term steroid use – C.O.P.D. Advanced Age Need for other major operative procedures Severe deconditioning Patients with arthritic or orthopedic problems Diabetics

    16. Contraindications* Contraindications Emergency cases Patients with hemodynamic instability Potential Contraindications Morbid Obesity Patients with posterolateral branch disease EF < 20% Patients with peripheral vascular disease (PVD) Patients with dilated cardiomyopathy Severe Pectus Excavatum

    17. Benefits of MICS CABG Complete Revascularization MICS CABG generally takes less time than normal CABG Maintains the same principals of normal off pump CABG Small 5 – 7 cm Posterior-Lateral Thoracotomy providing improved patient and referring physician satisfaction Shortened intubation time Quicker return to normal activities and less restrictions post surgery Increased referral base Marketing program opportunities for the hospital and physician

    18. Patients want MICS because… Less risk of infection (Dr. McGinn has a 0% infection rate with MICS) Less scarring – much better cosmetic outcome Shorter hospital stay – get home sooner Less pain, soarness and discomfort Much quicker recovery time (Days vs. Months) No broken bones, no post-operative sternal precautions Can get back to work much sooner (Days vs. Months) Don’t have to miss the entire golf or Tennis season (Weeks vs. Months) Overall less trauma to body

    19. Dr. Joseph T. McGinn Jr. Dr. McGinn pioneered MICS CABG and has performed over 400 procedures since 2005. He is the Chairman of General Surgery and the Director of Cardiothoracic Surgery at SIUH. He is also Medical Director of the Heart Institute. Dr. McGinn is triple board certified in general surgery, cardiothoracic surgery and surgical critical care and has performed more than 5000 cardiac surgeries to date. He is considered the U.S. authority on Minimally invasive cardiothoracic surgery and trains surgeons from all over the world in MICS CABG.

    20. Watch Dr. McGinn perform a MICS CABG, hosted by Dr. Joseph Sabik III, MD, FACC, FACS - Chairmen of the Department of Thoracic and Cardiovascular Surgery at the Cleveland Clinic www.ORLive.com – Type in “MICS CABG”

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