Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

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The basics of a Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) surgery remain the same as traditional bypass surgery (CABG). An artery from your chest will be used to create a new blood supply to your heart muscle. The upper end of the artery is naturally attached to a branch of the aorta so only the lower end is cut and repositioned.

Because of the location of the blockage in your heart's circulation, your surgeon is able to operate through a smaller incision. The incision can be made in one of several ways and is dependent on your anatomy and the location of the blockage. An artery can be taken from either the right or left side. A small operating camera (scope) and surgical instruments may be placed through three small incisions in the side of your chest between your ribs to take down the artery used to bypass your blocked heart vessels.

Incision Approaches

Surgery will be performed while your heart is beating; therefore, it will not be necessary to use the heart-lung bypass machine for support. This will greatly reduce the risk of post-operative bleeding, stroke, and kidney failure. Your surgeon will discuss your individual case with you and answer any questions that you may have.

Risk Factors

Your physician will discuss these with you at the time of your appointment.

What to Expect Before Surgery

You will be asked to discontinue aspirin or any anti-clotting drugs 1 week before the surgery. A nurse will go over your specific instructions prior to surgery.

What to Expect During Surgery

The surgery generally takes between two and four hours. During this time, you will be asleep.

What to Expect After Surgery

Immediately following surgery you may have the following:

  • Breathing Tube: there is a small chance that there will be a tube in your mouth connecting you to a breathing machine after surgery. You will be unable to talk when this is in. This tube will be removed as early as possible. You may have a sore throat or hoarseness afterwards.
  • Intercostal/Epidural Catheter: A small tube will be placed during surgery either near your incision or in your back. It will bring a local anesthetic to the nerves that cause pain to make you more comfortable after surgery.
  • Chest Tube (drain tube): A tube will be placed during surgery near your incision. It will allow drainage of any fluid from your chest cavity. The tube may be removed as early as the evening of surgery.
  • Intravenous Catheter (IV): One of two IVs may be placed. This generally takes place after arrival to the operating room. One will be in the side of your neck and the other in your arm. These IVs will be removed when you are taking fluids by mouth and don't require any IV medications.
  • Foley Catheter (bladder tube): A catheter will be placed in your bladder. This is for the collection of urine. It will be removed when your IV comes out.

After surgery, you will be uncomfortable, but pain medication will be available. It is very important that you take your pain medication after surgery. It will allow you to perform your breathing exercises and increase your activity sooner. Your nurse will ask you to rate your pain on a scale of 1-10. If the medication is not working, please let your nurse know.

You will also feel tired. This is normal, but it is essential that you do your coughing and breathing exercises. Take rest periods when you can.

You will dangle on the edge of the bed and get up in a chair the night of surgery. You will begin to walk the following day and moderate exercise will be started. Your family can help by walking with you when you are steady on your feet.

Going Home

Many patients will go home after surgery in 2-3 days. Your active participation will promote a quicker recovery. Some things to remember are:

  • Your energy will return gradually. Continue to increase your activity but listen to your body. Some days will be better than others.
  • Your appetite may be decreased. It is common to lose 5-10 pounds.
  • You may have some discomfort and muscle aches. This will lessen with time. Take pain medication as needed.

Special Instructions when at Home:

  • Do not lift more than 5 kg or participate in act sports for two weeks.
  • Driving and sex can generally be resumed in two weeks, if you are comfortable.
  • Continue to do your arm and deep breathing exercises for the first two weeks.
  • Continue to exercise as you were instructed in the hospital.
  • Your return to work is dependent on your type of job and your physician’s recommendations.


You are asked to return to see your doctor four weeks after surgery. Later follow-up including an angiogram three months after your surgery will be arranged at that time. See your other physicians as instructed.