Coronary artery disease is caused by the narrowing or occlusion of the arteries supplying the heart muscle due to atherosclerotic plaques. For severe blockages not amenable to stenting, bypass surgery remains the gold standard treatment to ensure optimal myocardial perfusion.

In traditional bypass operations, the breastbone is completely divided (median sternotomy) to access the heart. Today, utilizing high-definition surgical optics and micro-stabilizers, the procedure is successfully performed through a small incision between the ribs under the left chest (MIDCAB - Minimally Invasive Direct Coronary Artery Bypass).

How Is Minimally Invasive Bypass Performed?

The surgery is performed under general anesthesia. Through a discreet small incision beneath the left breast fold, the left internal mammary artery (LIMA) is harvested with specialized illuminated retractors. This natural, resilient conduit is then anastomosed to the obstructed main coronary artery (LAD), restoring robust blood flow.

  • Beating Heart Surgery: In the vast majority of cases, the bypass is performed on the beating heart without arresting the heart or using a heart-lung machine.
  • Preserved Sternum Integrity: Because the sternum is not divided, thoracic stability, bone integrity, and natural breathing mechanics remain completely intact.
  • Longest-Lasting Graft: The internal mammary artery (LIMA) is the body's most durable and occlusion-resistant bypass conduit, boasting over 90% patency at 20 years.

Who Is an Ideal Candidate for Small-Incision Bypass?

Small-incision coronary bypass surgery is a lifesaving and significantly more comfortable option for many patient groups:

  • Single or Double Vessel Disease: Especially patients with critical stenosis of the left anterior descending (LAD) artery benefit maximally from MIDCAB.
  • Diabetic Patients: In diabetic patients, sternotomy carries higher risks of bone infection and non-union; small incision avoids these complications.
  • Elderly and COPD Patients: Preserving the ribcage integrity accelerates pulmonary recovery and mobility in patients with diminished lung capacity.
  • Hybrid Revascularization: LIMA-LAD bypass combined with percutaneous catheter stenting of other vessels provides optimal long-term survival.

“Patients undergoing small-incision bypass ambulate the next morning, are discharged on day 4, and are able to drive within two weeks.”

— Dr. Taha Özkara

The fear of sternal division and months of immobilizing recovery is a thing of the past. Following careful cardiovascular imaging, suitable candidates can choose this advanced approach for rapid return to active life.