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MICS CABG The right procedure for the right patient

Supporting your choice of surgical therapies for your patients with coronary artery disease (CAD).

MICS CABG can reduce recovery times1

For your cardiac surgery patients who ask about faster recovery times, consider recommending a minimally invasive coronary artery bypass graft (MICS CABG) approach. MICS CABG is a beating heart procedure in which the anastomoses are performed under direct vision through an anterolateral mini-thoracotomy. The internal mammary artery (IMA) harvest can also be performed under direct vision, thoracoscopically or robotically. To achieve complete revascularization, a pump-assisted beating heart approach or hybrid coronary revascularization may be performed. Like OPCAB, MICS CABG requires special training and instrumentation to help you achieve enhanced visualization.

Clinical benefits

Patients who undergo MICS CABG have similar outcomes to the conventional beating heart procedure, but with the added benefit of eliminating the median sternotomy and associated morbidities.1,2 Additional benefits include:

  • Reduced length of hospital stays and recovery times even further than traditional on-pump or off-pump CABG3
  • Enduring results (LIMA-LAD)4
  • Fewer post-op physical restrictions4
  • Improved cosmetic outcomes versus a sternotomy5

Patient selection criteria6

MICS CABG is effective for many cardiac patients, but not all. Consider the following criteria when deciding if your patients are eligible for the procedure.

  • Left main coronary artery disease (CAD) with normal right coronary artery (RCA)
  • Three-vessel disease with medium to large posterior descending artery (PDA) or left ventricular branch of the RCA
  • Complex proximal left-sided lesions with or without large branch involvement
  • Previous unsuccessful stenting
View MICS CABG procedure video

Our technologies enable direct visualization

More than 20 years ago, when we introduced the Octopus™ tissue stabilizers for OPCAB, it changed the way cardiac surgeons could perform beating heart surgeries. For the first time, epicardial tissue could be stabilized using vacuum-assisted technology, making direct visualization possible and completing anastomoses easier on a beating heart. Today, tissue stabilizers are seen as standard for beating heart therapies.

We continue to offer the innovative technologies that help you perform MICS CABG procedures. These include the Medtronic Octopus Nuvo™ tissue stabilizer, Starfish™ NS heart positioner, and ThoraTrak™ MICS retractor system. These devices are shown below as positioned in the body during a MICS CABG procedure.

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Illustration of abdomen showing placement of Medtronic Starfish™ NS and Octopus™ Nuvo shafts in OPCAB surgery

Octopus Nuvo tissue stabilizer

New ways of working together

Minimally invasive cardiac surgery (MICS) procedures like MICS CABG are becoming more mainstream today. As the patient population changes, so do the demands on you, the cardiac surgeon. That’s why Medtronic is committed to supporting MICS CABG. Together — with your skilled knowledge and our enabling technologies — we can deliver the right therapies for each individual patient with coronary artery disease (CAD).

Learn new beating heart skills and gain hands-on experience with technologies that may be new to you. We offer a full range of training programs. Contact us to learn more.

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References

1

Puskas J, Cheng D, Knight J, et al. Off-Pump versus Conventional Coronary Artery Bypass Grafting: A Meta-Analysis and Consensus Statement From The 2004 ISMICS Consensus Conference. Innovations (Phila). Fall 2005;1(1):3–27.

2

Puskas JD, Thourani VH, Kilgo P, et al. Off-pump coronary artery bypass disproportionately benefits high-risk patients. Ann Thorac Surg. October 2009;88(4):1142–1147.

3

McGinn JT Jr, Usman S, Lapierre H, Pothula VR, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients. Circulation. September 15, 2009;120(11 Suppl):S78–S84.

4

Poston RS, Tran R, Collins M, et al. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. October 2008;248(4):638–646.

5

Lemma M, Atanasiou T, Contino M. Minimally invasive cardiac surgery-coronary artery bypass graft. Multimed Man Cardiothorac Surg. Published online June 28, 2013.

6

McGinn J, Ruel M. MICS CABG single-vessel plus multi-vessel techniques. Medtronic. April 2023.

Key risks

Patients undergoing a Minimally Invasive Coronary Artery Bypass Grafting procedure are at risk of the following, not inclusive: stroke, renal failure, infection, need for transfusion, incomplete revascularization, death.

Key risks of Octopus™ tissue stabilizers include: hematoma, laceration, ischemia, EKG/ECG changes, abrasion.

Key risks of Starfish™ heart positioners include: tissue damage, infection, dissection, ischemia, laceration, and organ dysfunction.

Key risks of the ThoraTrak™ MICS retractor system include: infection, laceration, and tissue damage.

Important safety information

Not all patients are candidates for beating heart procedures. Some patients would require cardiopulmonary support during surgery. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For a listing of indications, contraindications, precautions, and warnings, please refer to the Instructions for Use.