Median Sternotomy

Coronary Artery Bypass Grafting is a procedure performed exclusively by cardiothoracic surgeons. The traditional technique involves an incision down the front of the chest through the breastbone or sternum. This incision is called a median sternotomy. Through this incision the

surgeon can see the heart and aorta.

The procedure as traditionally performed requires that the patient be connected to the heart lung machine while the bypasses are being performed. The heart can then be stopped using a special mixture of chemicals called cardioplegia. After the bypasses have been performed, the patient is taken off the machine, and his/her own heart takes over once again.--- All bypasses were originally performed using saphenous vein from the leg to carry blood around the obstruction. The vein was attached at one end to the aorta and at the other end to the coronary artery beyond the blockage. The surgeon connects the vein to the aorta and to the coronary artery.

In the 1970s and 1980s, cardiothoracic surgeons discovered that an artery from the inside of the chest wall, the internal thoracic artery (also known as the internal mammary artery), could be used instead of the vein for the bypass. It has since also been learned that patients who receive an internal mammary artery graft to the main artery in front of the heart live longer.

Robotic Heart Surgery

The miniaturized instruments of the da Vinci Surgical System allow the surgeon to access the heart and its vessels through tiny incisions in the chest, rather than creating an incision through the breastbone or sternum. The smaller incisions result in a shorter hospital stay and more rapid return to full activities.

The da Vinci Surgical System works well for a CABG because the Vision System gives the surgeon a 3-D, 10 times magnified view of the operating field, providing an excellent view of delicate tissue and organs. It is particularly suited for placing the internal mammary artery to the main artery in front of the heart (LAD).

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