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Minimally Invasive Direct Grafting(MIDCAB)

This surgery differs from that of a traditional CABG, the reason is the surgeon does not open the chest bone to reach the heart, instead a several crust are made on the left side of the chest bone which is between the ribs, this type of procedure is mainly used to bypass blood vessels at the front of the heart.

Minimally Invasive Direct grafting , is a brand new and fair procedure, however it is not right for everyone, especially if more than one of the coronary arteries need to be bypassed.

Who Needs Grafting?

This procedure(CABG) is used to treat people who have an issue with severe CHD, which could lead to a heart attack. This process is used(CABG) is used to treat blocked arteries before or after an heart attack.

The doctor would recommend CABG, if there are no significant change in your medication and lifestyle. This procedure would be done if you have a severe case of blockage in the large coronary artery, and the pumping action of the heat is gone weak.

Your Primary care physician will decide, whether, you are suited for CABG, which are based on various factors such as:

  • If you have severe symptoms of CHD
  • Depending on how severe the blockages are in the coronary arteries
  • How you respond to the treatment
  • The lifestyle you lead
  • Other medical problems

Physical Exam and Diagnostic Tests

To see if you suit the procedure for CABG, the doctor will ask you to take a physical exam. The doctor will examine your heart chest , pulse and lungs.

The doctor will check with your what symptoms you are experiencing , like shortness of breath, any chest pain of shoulder pain, and how long their are how severe it is.

The physician will recommend that you go through some tests, to find out which arteries are clogged, and how severe it is and whether is could lead to a heart disease.

EKG (Electrocardiogram)

This is a simple test which detects and also records the hearts electrical activity. This test will show how fast your heart is beating,and also its rhythm. It also records the strength and timing of electrical signals as they pass through part by part of the heart

It also records damage signs of the heart due to CHD, and also show signs of a previous heart attack.

Electrocardiography

It uses sound waves, to create a moving picture of the heart. This test determines the size shape of the heart and how well the heart is working.

It can also detect poor blood flow to the heart, areas of the heart muscle, which are not contracting normally and any previous injury to the heart muscle which has caused the poor blood flow.

There are also several types of echoes, including a stress echo, this test is done to determine whether you have a lack of blood flow to your heart , also a sign of CHD, this test is done before and after a stress test.

Stress Test

Usually with exercise the heart speeds up and beats faster, but when doing a stress test, the physician would give you medication to raise your heart rate to conduct the test.

The tests done during a stress test, are nuclear heart scanning, echo, position emission tomography(PET) scanning of the heart.

Coronary Angiography and Cardiac Catheterization

To look at the inside of of the coronary arteries a dye is used and special x-rays, known as a coronary Angiography.

To use the dye the doctor will use a method called Cardiac Catheterization.

A catheter, a thin flexible tube, is put inside a blood vessel in the arm, groin(upper thigh) or the neck, the tube is then threaded into the coronary artery, and then the dye is administered into the blood stream.

A number of x-rays are taken while the dye is being administered into the coronary arteries, this dye helps the doctor to study the blood flow through the heart and the bloods vessels and also helps the doctor to find any blockages that can cause a heart attack.

What To Expect Before Grafting

There are several tests which you would prepare you before the Grafting like,EKG (electrocardiogram), electrocardiography, a chest x ray, cardiac catheterization, and coronary angiography.

The doctor will explain and tell you how to prepare for a CABG surgery, the physician will let you know what you can eat and drink, and which medication to take and what you can and can't do especially(such as smoking).It is most likely that you be admitted in the hospital on the same day of the surgery.

If the tests indicate that you have severe blockages in the coronary(heart) arteries, then the doctor would admit you in the hospital right away,the procedure would be followed on the same day or the next day.

What To Expect After Grafting

Your recovery would start in the hospital

After the surgery, you would spend at least 1-2 days in the intensive care (ICU). The health care team checks all your vital signs, and oxygen levels at regular intervals.

An IV (intravenous) would be inserted into the vein in the arm, the medication would be administered through the IV line , these medications help to control the blood flow and the blood pressure,and also you will have an tube in the your bladder to drain the urine and a tube in your chest to drain fluid.

The physician would provide oxygen through a mask or nasal prongs, and a temporary pacemaker while you are in the ICU. The pacemaker is a small device to monitor irregular and abnormal heart rhythms, and this is a small device is placed in the chest or abdomen.

The physician also recommends that you wear compressed stockings on your legs, these stockings help the blood from pooling and clotting.

In the ICU you will have also bandages on your chest where the incision is, on the area where the arteries or veins are removed from grafting.

When you leave the ICU you will be moved to a private room of the hospital for 3-5 before going home.

Recovery at Home

The doctor will give you instructions when you go home such as:

  • How to take care of the incisions
  • The physician educates you on how to recognize signs and infections and other complications
  • To follow-up on appointments, and when to call the doctor

The physician will guide you on how to deal with common side effects,usually these side effects go away within 4-6 weeks after surgery.

  • You may experience itching from healing incisions
  • Swelling on the area where the incision was made
  • Muscle pain or tightness in the shoulders and upper back
  • Feeling weak , mood swings or depression
  • Problems sleeping or loss appetite
  • Constipation
  • Experiencing chest pain at the site of chest bone incision(more frequent with traditional CABG

It would take up to 6-12 weeks or more to recovery from a traditional CABG, a non- traditional CABG doesn't require as much recovery time. The doctor will advise you when you can become active again. It varies from person to person , but there are some typical time frames.

After about 6 weeks, patients resume from sexual activity and return to work. Some people may need to find less physically demanding types of work .

Your physician will tell you when you can resume to your normal activity, including sexual activity, working and driving.