Just Like A Smart Phone A Smart Bypass

Just like a Smart phone, a Smart Bypass: MICS, Minimally invasive cardiac surgery. Yielding significant benefits for not just the patient, but for the entire health care system.

The technological advances in cardiac surgery have now made possible for a Heart Surgery to be conducted only via a 5cms cut, similar to a keyhole, in the chest. However, it is not just the size of the cut, but the total avoidance of cutting the breast bone or of the sternum that translates into all the advantages. There is minimal loss of blood and the requirement for transfusion is almost eliminated. Pain too is minimal with very low chances of wound infection. There are no limitations on movement or activity after this procedure. All of the above are only possible as the surgery has been performed by going between the ribs and avoiding cutting the bone.

After a routine bypass surgery there are certain precautions to be followed for about 3 months to ensure a steady reunion of the surgically fractured bone. These precautions are not required with MICS and this allows people to resume their work as early as 7 days post surgery.

This surgery is possible because of a special retraction system that spreads the ribs vertically up and down rather than sideways, thus providing the required access to the heart. There are no doubts that this surgery is more technically demanding and requires a bit of hard work on the part of the surgeon when operating. But the real benefits are reaped by the patients when they get to go back home on day 3 post surgery and resume their work only a week post discharge.

This surgery however, cannot be performed on every patient. If the damage to the heart is too severe and there is significant dysfunction, it is better to proceed with a conventional bypass as that procedure can tackle other possible worse case scenarios more effectively.

This surgery requires a special Anesthesia which deflates only one lung, allowing it to be kept out of the way. This procedure allows the other remaining lung to function as normal during the procedure. However, this means anyone suffering from an advanced lung disease may not be a suitable candidate for this operation. Obesity and bulky chest walls may make this operation difficult to perform. Similarly, an emergency or Recent Heart attacks may also preclude this surgery.

MICS is possible because of special retraction system that spreads the ribs up and down and not side ways and thus providing the access to heart, says Dr Vaibhav Mishra, Director & Head, Cardiac Surgery, Max Superspeciality Hospital, Patparganj, Delhi

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The other details of the operation like number of grafts and anastomotic techniques remain the same. The underlying principle of any bypass surgery is to increase the blood flow to the heart by making alternate channels which allow to bypass the native vessel afflicted with the obstruction.

Even if there are many reasons not to do it, there are so many to do it and in short nearly half of bypass surgeries can be done this way. Another disadvantage with conventional bypass via Sternotomy is that the retraction of the cut edges of bone usually results in significant limitations of movement and there is voluntary splinting of chest by the patients and shoulder stiffness. Some patients may also experience Neurological symptoms in hands like tingling or numbness.

Since MICS is done via a small cut and going in between the ribs, there is minimal retraction of the chest wall and minimal anatomical disruption, resulting in faster mobilization and full functional recovery without any precautions or preconditions. Minimally invasive bypass yields a significant benefit for not just the patient but for entire health care system.

No blood transfusion, minimal analgesic requirement, no wound infection, no limitations on shoulder and hand movements, discharge from Hospital as early as day 3 of procedure and return to work within 10 days with full functional capacity makes this operation a smart choice. Hence, the name smart bypass, just like smart phones. This is not just small in size but also comes with a host of other advantages.

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