Bilateral Internal Mammary Artery (BIMA) through Minimally Invasive Cardiac Surgeries (MICS) was introduced for the first time in Eastern India.

Coronary Artery Bypass Grafting (CABG) using internal mammary artery is a novel technique, which gives best long lasting outcomes. Usually, BIMA grafting is done through standard techniques of a midline bone cutting incision where multiple grafts can be inserted. Recently the team of cardiac surgeons in Apollo Gleneagles Hospitals, Kolkata, started this technique of BIMA through minimally invasive coronary surgery techniques.

CABG in India is conventionally performed by splitting or cutting through the breastbone or sternum. CABG through MICS is considered to be a safe and complete operation and has revolutionised the way coronary surgery is performed, the advantages being obvious. There is no bone cutting incision in the centre of the chest, the incision size is small, the pain is less, the blood loss is less and the patient can get back to work much sooner. It is also advantageous in that elderly and frail patients who fail to withstand midline bone cutting surgery can be easily efficiently managed when incisions are small (2 inches).

Outcomes have been encouraging in cases of patients who have undergone this procedure. The advantage of using BIMA through minimally invasive method is that sometimes when BIMA is done through the sternal incision there can be a sternal necrosis and sternal dehiscence, which can be problematic and sometimes life threatening. However, because there is no bone cutting in BIMA grafting through MICAS, the issue of bone necrosis and bone non-healing does not arise at all. Thus, there are the advantages of total arterial grafting while the disadvantages of sternal devascularisation can be negated
through this technique.

Present on the occasion, Dr. Sushan Mukhopadhyay, Director, Cardio Thoracic & Vascular Surgeon, Apollo Gleneagles Hospitals, Kolkata expressed, “We have been doing MICS coronary artery bypass grafting since last 6-7 years and have done more than 1,500 such surgeries. Recently, we have started doing bilateral internal mammary artery grafting through
a small 2 inch left sided incision in the thorax to harvest both the internal mammary arteries.” “The internal mammary arteries from both sides can be either used in situ or can be used in a y technique. We have been doing such grafting technique very efficiently with very good outcomes. I think this technique of CABG will take us long way into the future of cardiac surgery,” Dr Mukhopadhyay added.

MICS has several advantages over the conventional open heart surgery: Highly advanced instrumentation and advanced techniques allow for the operation to be performed very safely. No bones are cut . Blood loss is almost negligible eliminating blood transfusion leading to blood borne infections and diseases All infections related to wounds or post-operative lung infections are reduced. This makes the surgery ideal for diabetics or patients who have poor resistance to infection.

The incision is very cosmetic and measures just 2-3 inches making it impossible to understand that a heart surgery has been done. This also reduces the possibilities of scars. The hospital stay and recovery time in this case is minimal and the patient usually recovers within 7 days of the surgery under normal circumstances significantly reduced risked factors in future surgeries.