MIDCAB surgery

  I have a question regarding what criteria is used to determine whether a person is a candidate for MIDCAB surgery.  My dad is scheduled to see Dr. Lytle at the end of March and we are anxiously awaiting this consultation. We are grateful to be able to bring him to such an outstanding heart center and hope that your clinic will be able to help him. He is 77 years old and is considered morbidly obese at 325 lbs.
  My question is, would just these two risk factors alone exclude him from MIDCAB surgery?  Wouldn't this type of surgery be safer for him than the traditional open heart surgery? Do you perform minimally invasive bypass surgery on high risk patients? I've read that you are doing all kinds of innovative things in this area.  I'm certain there are numerous factors that go into this decision, but was just wondering if he would even be considered for it.
  Thank you so much for taking the time to answer me. I truly appreciate it and I think this forum is terrific..  It's been a hard time and I'm just trying to be as informed as possible. On a lighter note, do you know if Dr.Lytle is also a Bruce Springsteen fan?  I found a journal article where he quoted him and just wondered?!   April

[CCF Cardio MD - MTR]

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Dear April, thank you for your question.  MIDCAB surgery as you know involves bypassing coronary arteries while the heart is still beating by using novel stabilizing devices.  The benefits of this surgery are that the patient is not exposed to the risks of cardiopulmonary bypass (stroke, bleeding, infection) that is normally used to maintain the circulation while the heart is stopped and that smaller incisions can sometimes be used to perform MIDCAB surgery.  However, the cardiac surgeon has to have unique expertise to accomplish this technically demanding surgery.  High-risk patients that need bypass surgery have the most to gain from MIDCAB surgery since these patients have the highest complication rates from traditional bypass surgery.  Typical risk factors for bypass surgery include advanced age, left ventricular dysfunction, renal insufficiency, pulmonary disease, and obesity.  Your father may be considered high-risk due to his age and weight.  It's difficult to say if MIDCAB surgery can be done on your father, but since he is obese, it may be too demanding for the surgeon to cut through extra tissue to reach the heart to do a MIDCAB surgery.    Also, MIDCAB surgery is usually only done on one coronary artery, so if your father needs multiple bypass grafts, then he will probably need traditional bypass surgery.   At the Cleveland Clinic, we are taking innovative approaches to bypass surgery and I'm sure your father will have every available option considered for him.  However, the decision will be made by Dr. Lytle, so I can't make any specific comments on what type of bypass surgery your father will be offered.  Finally, I don't know about Dr. Lytle's musical tastes, but he may very well be a fan of The Boss - you should ask him!

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.