Endoscopic Coronary Bypass Surgery

Coronary artery disease is caused by atherosclerosis narrowing or blocking the vessels feeding the heart muscle. In modern cardiac surgery, minimally invasive and endoscopic coronary artery bypass (MIDCAB) is performed on the beating heart through a small small incision under the left breast, completely without cutting the breastbone or connecting to a heart-lung machine.

Coronary Artery Disease and the Philosophy of Endoscopic Bypass

In traditional coronary bypass operations, the breastbone (sternum) is fully divided, and the patient is placed on a heart-lung cardiopulmonary bypass machine. This introduces significant risks of bleeding, systemic inflammation, neurocognitive dysfunction, and sternal bone dehiscence or infection, particularly in diabetic and elderly patients.

Dr. Taha Özkara utilizes high-definition endoscopic camera guidance and advanced coronary stabilization systems to access the left anterior descending (LAD) and diagonal coronary arteries through an intercostal small incision, ensuring maximum revascularization while completely sparing the thoracic skeleton.

Surgical Technique: LIMA Grafting & Beating Heart Microsurgical Precision

The Left Internal Mammary Artery (LIMA)—the gold standard coronary bypass graft with over 95% 10-year patency—is harvested under direct high-magnification endoscopic visualization through the small intercostal window. Special micro-vascular instruments allow delicate skeletonized or pedicled LIMA harvesting without any rib fracture.

Using specialized cardiac vacuum stabilizers, only the target diseased coronary segment is immobilized while the remainder of the heart continues beating normally. Under 4x-6x surgical loupes, a continuous microvascular anastomosis is constructed using 7-0 or 8-0 monofilament sutures, establishing immediate robust coronary myocardial perfusion.

Clinical Superiority & Advantages Over Traditional Open Bypass

By completely eliminating sternotomy and extracorporeal circulation, off-pump endoscopic bypass dramatically reduces systemic surgical trauma and accelerates patient recovery:

Recovery Period, Hospital Discharge, and Patient Suitability

Following surgery, patients are extubated within a few hours and transition from the intensive care unit to a private room the next morning. Because bone healing is not required, deep breathing exercises are pain-free and pulmonary complications are virtually eliminated.

Endoscopic coronary bypass is particularly ideal for patients with isolated LAD or multi-vessel disease suitable for hybrid revascularization, as well as high-risk diabetic, COPD, and elderly patients where traditional sternotomy carries elevated morbidities. Contact us with your coronary angiography images for a comprehensive evaluation.