Coronary Artery Bypass Surgery Through a Mini Thoracotomy (ThoraCAB)

Coronary artery bypass surgery through a mini thoracotomy (ThoraCAB) is an advanced, minimally invasive method to perform bypass surgery without splitting the breastbone. Performed through a 2- to 5-inch incision, ThoraCAB offers many advantages compared to traditional open-chest bypass surgery, including a faster recovery and less pain. In addition, the heart is not stopped during ThoraCAB, reducing the need to use a heart-lung bypass machine. In some cases, ThoraCAB is performed in collaboration with cardiologists who insert stents to prop open some of the blocked arteries, an approach called hybrid coronary bypass surgery.

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 by physicians from the University of Chicago Medicine?

Q. What is ThoraCAB? How is ThoraCAB performed?
A. ThoraCAB stands for coronary artery bypass surgery through a mini thoracotomy. ThoraCAB keeps the breastbone intact -- there is no "cracking of the chest" with this approach. With ThoraCAB, surgeons make a small, 2- to 5-inch incision at the side of the chest to gain access to the heart to perform the bypass procedure.

The da Vinci Surgical System is typically used to obtain internal mammary arteries for bypass grafts. This sophisticated robotic system gives the surgeon improved access and visualization inside the chest. After the grafts are prepared, the rest of the procedure is performed directly on the beating heart through the small incision at the side of the chest.

Our surgeons use one or both 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.

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 three weeks, compared to eight to twelve 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.
• Quicker resolution of pain. A smaller incision and no splitting of the breastbone results in quicker resolution of pain and less need for pain medications.
• 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.
• Reduces the need for 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
• 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 2- to 5-inch scar or multiple very small scars, 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.

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. Surgeons must review medical records and images of the heart's arteries to determine if ThoraCAB is a suitable approach.

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 using a sternal incision.

Q. Is ThoraCAB widely available? What's different about ThoraCAB performed by physicians from the University of Chicago Medicine?
A. ThoraCAB, and a similar procedure called MIDCAB, are not routinely performed at most hospitals. ThoraCAB is a technically demanding procedure that involves specialized teams with unique 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.

More Information

• ThoraCAB: Mini Thoracotomy Bypass
• Off-Pump, Beating-Heart Bypass
• Traditional Open Bypass