Coronary Artery Bypass Surgery Through a Lateral Thoracotomy (ThoraCAB)
Coronary artery bypass surgery through a lateral thoracotomy (ThoraCAB) is performed through one small, 3- to 5-inch incision on the side of the chest. This procedure provides many advantages compared to traditional open-chest heart bypass surgery, such as a faster recovery, less pain, and no splitting of the breastbone. ThoraCAB is typically performed with robotic assistance, and most often on a beating heart.
Video: Animation of ThoraCAB Surgery
- What is ThoraCAB? How is ThoraCAB performed?
- What are the benefits of ThoraCAB?
- Who is a candidate for the ThoraCAB approach?
- Is ThoraCAB widely available? What's different about ThoraCAB performed at the University of Chicago Medical Center?
Sudhir Srivastava, MDQ. What is ThoraCAB? How is ThoraCAB performed?
A. ThoraCAB stands for coronary artery bypass surgery through a lateral thoracotomy. In 2000, Sudhir Srivastava, MD, now a cardiac surgeon at the University of Chicago Medical Center, developed the procedure while working at a Texas hospital.
Like the TECAB procedure, the ThoraCAB keeps the breastbone intact. With ThoraCAB, surgeons make a small, 3- to 5-inch incision at the side of the chest to gain access to the heart to perform the bypass procedure. The surgeon can perform ThoraCAB directly operating on the heart, or with the assistance of the da Vinci Surgical System, a sophisticated robotic surgery device that gives the surgeon improved access and visualization of the heart and vessels. An advantage of the da Vinci is that it enables the surgeon to more easily harvest internal mammary arteries for bypass grafts. In a ThoraCAB procedure, the da Vinci is only used to obtain the bypass grafts -- the rest of the procedure is performed through the small incision at the side of the chest.
Our surgeons use two internal mammary arteries for bypass grafts because these are among the "cleanest" and most durable vessels in the body. The mammary arteries of the average 80-year-old are usually plaque-free. And because the breastbone is not split during a ThoraCAB procedure, our surgeons are not concerned that the mammary arteries are put to a new use--circulation is maintained in the thoracic cavity.
The heart is not stopped during ThoraCAB, so there is no need to use the heart-lung bypass machine.
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Q. What are the benefits of ThoraCAB?
A. ThoraCAB offers many benefits for patients. Compared to traditional, open-heart bypass surgery, the advantages of ThoraCAB include:
- Faster recovery. Most patients are back to work and/or other activities within a week to 10 days, compared to four to eight weeks with open-chest bypass.
- No splitting of the breastbone. Keeping the breastbone intact speeds recovery and lessens the chance for post-surgical complications or infection.
- Significantly less pain. A smaller incision and no splitting of the breastbone results in less pain.
- Shorter hospital stay. The typical ThoraCAB hospital stay is two to four days, versus five to seven for open-chest procedures.
- Heart continues to beat during the procedure. Keeping the heart beating reduces risks for complications.
- Elimination of the heart-lung bypass machine. Avoiding the bypass machine reduces the risks for neurological complications and stroke.
- Minimal blood loss and less need for transfusion
- Less trauma to the body
- Internal mammary artery grafts. These grafts are superior to vein grafts because they are better able to withstand blood pressure over time and are less likely to develop blockages, reducing the need for re-operation.
- Minimal scarring. The procedure results in only one, small 3- to 5-inch scar, versus a long chest scar.
ThoraCAB is a good option for people of any age who require coronary artery bypass surgery. For the elderly, ThoraCAB avoids complications with weakened bones due to osteoporosis.
As with any surgery, the hospital stay and recovery time may vary depending upon the overall health of the patient, and other associated risk factors.
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Q. Who is a candidate for ThoraCAB?
A. Currently, ThoraCAB is an option for most people who require coronary bypass surgery--including people who need as many as six or more grafts, and those who have had coronary bypass surgery in the past.
However, not all people are candidates for ThoraCAB. ThoraCAB is NOT an option for those who have recently had a stroke.
Ultimately, many factors are taken into consideration when surgeons select the best coronary artery bypass surgery approach for each patient. Even if ThoraCAB is not an option, our surgeons can frequently offer other coronary bypass solutions that provide benefits over the traditional approach, such as off-pump coronary artery bypass surgery.
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Q. Is ThoraCAB widely available? What's different about ThoraCAB performed at the University of Chicago Medical Center?
A. ThoraCAB, and a similar procedure called MIDCAB, are not routinely performed at most hospitals. ThoraCAB is a technically demanding procedure that involves specialized skills and training. Also, the preferred method of harvesting internal mammary arteries using the surgical robot can only be performed at hospitals with systems like the da Vinci.
Because the ThoraCAB approach was developed by one of our surgeons, we offer more experience with this procedure than any other hospital in the world. In fact, Dr. Srivastava has taught many other surgeons how to perform the procedure. This breadth of experience assures that people who come to the University of Chicago Medical Center for coronary bypass surgery directly benefit from the latest advances. All of our surgeons are dedicated to providing the best approach for each patient, and they are continually exploring options for making the surgical experience better for patients.
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More Information
- TECAB: Totally Endoscopic Bypass
- ThoraCAB: Lateral Thoracotomy Bypass
- Off-Pump, Beating-Heart Bypass
- Traditional Open Bypass
