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Endoscopic Bypass without Sternotomy
The next day in Cardiac Surgery at Athens Medical Center

Coronary artery disease, i.e. the narrowing or blockage of the vessels that supply blood to the heart, remains one of the most common causes of death. When these vessels can no longer adequately supply the heart muscle, the patient experiences symptoms such as chest pain, shortness of breath, severe fatigue, and even fainting episodes. The long-term solution in these cases is usually the surgical restoration of circulation through coronary artery bypass grafting, more commonly known as bypass.

Bypass is the most common cardiac surgery procedure worldwide.

More than 70% of heart surgeries involve this technique. Traditionally, this procedure is performed by opening the sternum, a procedure known as a “sternotomy,” so that the surgeon has direct access to the heart. Although this approach is effective and safe, it involves a significant surgical burden, a longer recovery, potential complications such as sternum infection or chronic pain, as well as a strong cosmetic imprint.

Bypass without opening the sternum in a beating heart

Today, technology, training and accumulated experience allow us to offer patients an alternative, less traumatic, but equally effective solution, endoscopic coronary artery surgery. This is a minimally invasive bypass method, which maintains the high effectiveness of the classic technique, but without requiring opening the chest.

How does the endoscopic method work?

The procedure is radically different from the traditional one. Instead of opening the sternum, we make three very small holes, smaller than one centimeter, in the lateral chest wall. Through these, a high-resolution endoscopic camera is inserted (3D, 4K) as well as specialized tools, with which we prepare the arteries that will be used as grafts. Specifically, we use the left and right internal mammary arteries, which have excellent patency over decades, compared to venous grafts.

After the grafts are prepared, the anastomosis, i.e. their connection to the coronary vessels, is performed through a small incision of approximately 6 centimeters, also on the lateral side of the chest. The entire operation is performed on a beating heart, that is, with the heart in operation, without requiring the cessation of circulation or the use of an extracorporeal machine, unless there are other indications.

What are the advantages for the patient?

This approach offers multiple benefits to the patient:

• Faster recovery: Patients are mobilized within a few hours and can return to their daily lives within a few days of discharge, without any restrictions on their movements. The absence of injury to the sternum eliminates the need for prolonged avoidance of weight lifting or trunk rotations, which are necessary in the classic approach.
• Fewer complications: The endoscopic method drastically reduces the possibility of infections, chronic postoperative pain and bleeding. In addition, there is a significantly lower need for blood transfusions.
• Excellent aesthetic result: The incision is located on the side of the chest, and in women it is made under the breast, so that it is essentially invisible. This plays an important role in the psychology of patients, especially in younger people and women.
• Exclusive use of arterial grafts: We systematically use the internal mammary arteries, which have a superior prognostic value over time, increasing long-term survival and reducing the need for repeat surgery.

Which patients can undergo endoscopic bypass?

This technique is suitable for all patients who have an indication for bypass. There are no absolute contraindications, apart from rare cases with particular anatomical or functional problems. In practice, any patient can be treated endoscopically, as long as they are in the hands of a specialized team with experience in the technique.

Endoscopic cardiac bypass surgery requires special training, many years of experience and advanced equipment. At present, the majority of cardiac surgeons still use the traditional method due to the lack of appropriate training and infrastructure. However, this is gradually changing, with the creation of specialized reference centers.

At the Minimally Invasive Cardiac Surgery Clinic of the Athens Medical Center, we apply exclusively endoscopic access for coronary bypass, being the only the center in Greece with this capability and experience.