July 17, 2023
CALGARY — A local surgeon recently completed the province’s first minimally invasive direct coronary artery bypass (MIDCAB) surgery at Foothills Medical Centre.
Cardiac surgeon Dr. Daniel Holloway grafted a blood vessel onto the patient’s heart to create a new path for blood to flow around a blocked artery – while the patient’s heart was still beating.
“This is a powerful example of how Alberta’s healthcare system is driven by innovation and patient-centred care,” says Adriana LaGrange, Minister of Health. “It also demonstrates how the Alberta Surgical Initiative provides the right care at the right time and, ultimately, gets Albertans the surgical care they need quicker while creating a sustainable system. Our congratulations to Dr. Holloway, the many teams who supported him, and the patient on this achievement.”
Traditional bypass surgery involves a full sternotomy: the patient’s breastbone is split apart to access the heart, which requires the patient to be on a heart and lung machine. With MIDCAB, the surgeon enters the chest cavity through a five- to seven-centimetre incision between the ribs, a much less invasive procedure.
“Now we have a minimally invasive option for eligible patients requiring a single bypass,” says Dr. Holloway, a clinical associate professor in the Department of Cardiac Sciences at the Cumming School of Medicine. “It’s very satisfying from a professional standpoint as the procedure is less complex and invasive. For patients, the recovery time is much shorter and easier.”
Calgarian Chris Kennedy, 40, was the second patient in the province to undergo the procedure when he had MIDCAB surgery in January. While he was surprised with the diagnosis he’d received just a month earlier, he said his experience has been positive and praised his care team’s efforts.
“I was told in late December that I had a pretty significant blockage in my heart and that I would require surgery,” says Kennedy. “I was shocked because, at 40, and being healthy, you don’t expect to have heart problems. I have no family history of heart disease, I don’t have diabetes, and I have never smoked.
“I received fantastic care,” he adds. “Three days after the surgery, I had regained a lot of my mobility, and I was able to drive just 10 days after my surgery and return to work.”
Sternotomy patients cannot drive for six weeks post-operation and generally return to work after two months. In addition to recovery times with MIDCAB being shorter, the procedure may also result in fewer complications since it is done on a beating heart with no need for a heart-lung bypass machine.
Dr. Holloway and his colleague, Ganesh Shanmugam, received MIDCAB training at Peter Munk Cardiac Centre at the Toronto General Hospital through funding and leadership support from the Libin Cardiovascular Institute. The procedure is relatively new and only done at a few sites in Canada.
“This has been a massive team effort,” says Dr. Holloway. “Not only did we have support from our leadership, but we also collaborated closely with our cardiac anesthesia group. Nursing, cardiology and surgical staff also played a big role.”
Cardiac anesthesiologists Dr. Christopher Noss and Dr. Douglas Seal also received MIDCAB training. The procedure requires specialized anesthetic techniques, including lung isolation or one lung ventilation; blood pressure and heart rate manipulation; and pain control, including unique nerve block techniques.
Dr. Noss is grateful to have taken part in Alberta’s first MIDCAB surgery and is confident the program will continue to grow.
“It’s rewarding to be part of an innovative team and to be pushing things forward,” says Dr. Noss. “This is a procedure that adds to our minimally invasive and enhanced recovery programs. It is safe and improves the quality of our patient’s recovery. It’s exciting to see that we are making a difference for patients.”
So far, six patients have undergone the surgery since January. Foothills Medical Centre is the only site in Alberta offering it. As more surgeons and anesthesiologists receive the required training, it is anticipated more eligible patients across the province will benefit from MIDCAB.
Approximately 900 coronary artery bypass surgeries are performed at Foothills annually.
Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Our mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans. Our current focus is on decreasing emergency department wait times, improving EMS response times, reducing wait times for surgeries, and improving patient flow.
