Stanford Leads the Way in Advancing Minimally Invasive Options
for CABG to Best Care for Patients
Across the nation, referring cardiologists and patients are seeking minimally invasive surgery, including robotic surgery, for coronary artery bypass grafting (CABG) - a procedure used to treat coronary artery disease. At Stanford Medicine, cardiothoracic surgeons are meeting that demand for advanced options in CABG. For patients, these minimally invasive CABG surgeries often mean less pain and a faster recovery.
“Cardiac surgeons at Stanford have long been leaders in minimally invasive approaches and coronary artery bypass grafting. We have had huge programmatic growth over the last decade in the quantity and quality of the cardiothoracic surgeries that we offer,” said Jack Boyd, MD, Clinical Associate Professor and Section Head of Coronary and Valvular Surgery in the Stanford Department of Cardiothoracic Surgery. Dr. Boyd performs more than half of the isolated CABG procedures at Stanford, and approximately 70% of his CABG surgeries involve multi-arterial grafting.
Today, Stanford is among a few centers in California with expertise in minimally invasive CABG, including robot-assisted and minimally invasive direct coronary artery bypass (MIDCAB). In recent years, minimally invasive CABG surgeries accounted for close to 20% of all isolated CABG procedures performed at Stanford.
Over the past decade, the team completed more than 2,600 CABG surgeries with a record high of 330 in 2024, and with excellent outcomes.
According to the Society of Thoracic Surgeons’ (STS) data, Stanford’s survival rates for CABG are higher than the national average, and significant complications are lower. With CABG, a healthy blood vessel, vein, or artery from the patient’s own body is used to bypass a blocked or narrowed coronary artery.
Robotic CABG at Stanford
Stanford’s robotic CABG volumes have increased steadily in the last several years. The department is focused on continuing to grow its number of robotic CABG and MIDCAB procedures.
“While there has been a heightened interest in robotic CABG, less than 1% of all bypasses are done robotically today in the United States,” said Dr. Boyd.
Dr. Boyd and Élan Burton, MD, MHA, Clinical Associate Professor, specialize in robotic CABG surgeries at Stanford Medicine. In August 2023, Dr. Burton completed the first robotic-assisted MIDCAB at the Veterans Affairs Palo Alto Health Care System, paving the way for more patients to receive the procedure.
"Robotic-assisted MIDCAB surgery is a highly specialized procedure that Stanford is proud to offer, making us one of the few heart centers in Northern California to provide this advanced option,” said Dr. Burton, Head of the Stanford Medicine Affiliates Section.
Dr. Burton is enthusiastic about increasing the volume of robotic surgeries at Stanford. She uses a specialized technique when performing a MIDCAB surgery, requiring harvesting the patient’s left internal mammary artery (LIMA) utilizing three robotic arms. The coronary artery bypass graft to the left anterior descending artery (LAD) is then completed through a small left anterior thoracotomy incision, which is typically created by extending one of the robotic port access incisions. This advanced technique is used by all cardiothoracic surgeons at Stanford to perform the robotically-assisted procedure.
“We take a pretty aggressive, yet safe, approach to expand the patient candidacy for robotic MIDCAB. Using a technique known as a hybrid MIDCAB, I perform the LIMA to LAD bypass graft first. Typically, during the same hospital admission, one of my interventional cardiology colleagues will stent other diseased vessels. This provides the patient with complete revascularization without an open sternotomy,” she said. This approach is especially beneficial for patients with mobility issues who may have problems with rehabilitation after traditional sternotomy or patients who have no conduit (vessel) available for surgical bypass.
Recently, she performed minimally invasive robotic MIDCAB surgery on a patient who had no promising conduits due to disease and past surgeries. The patient, who had a chronic total blockage of the obtuse marginal (OM) coronary artery with collateral vessels, did well throughout the surgery and during recovery. Today, the patient is free of chest pain.
“Traditionally, most people think MIDCAB applies only to patients with one vessel disease, but we are showing it can be broadened to multivessel disease,” she said.
Robotic CABG surgeries are reserved for patients who are stable and who present with non-stentable isolated LAD disease or multivessel disease in which a full surgical revascularization is not possible.
Stanford cardiac surgeons tailor surgical choices to each patient’s individual needs and only offer minimally invasive options when they believe they can provide good long-term results.
Leaders in CABG with Multi-arterial Grafting
Stanford’s Revascularization Program offers different types of bypass grafting for CABG, including multi-arterial grafting, which has been reported to have better success and possibly a lower chance of needing another bypass surgery in the future. Multi-arterial grafts include bilateral internal mammary artery (BIMA) and radial artery CABG. BIMA uses arteries in the chest, and radial artery bypass uses an artery from the patient’s forearm.
In 2024, the Stanford team reached a record high of CABGs with multi-arterial grafting, those utilizing radial arteries and/or a second internal mammary artery, reflecting their emphasis on lasting, evidence-based techniques. Close to 40% of Stanford patients with stable coronary artery disease undergo multi-arterial grafting, four times the national average. Stanford’s percentages for performing these procedures are higher than most other heart centers in the United States.
“The bypass we offer for minimally invasive or robotic CABG is still the best revascularization treatment we have, but with less invasive incisions. In our revascularization program, we offer the entire gamut of options to our patients, and we steadily increase our volumes and achieve great results,” said Dr. Boyd. “We are standing on the shoulders of giants who came before us, and our cardiothoracic surgeons continue that legacy, achieving outcomes that are among the best in the country.”
Stanford’s collaborative spirit and drive for innovation are central to the program's success. “Led by extremely talented and skilled surgeons like Dr. Boyd and Dr. Burton, our team is committed to delivering world-class, life-saving treatments for our patients," said Joseph Woo, MD, Department Chair and Norman E. Shumway Professor of Cardiothoracic Surgery.
By integrating surgical excellence with a culture of ingenuity in minimally invasive CABG procedures, Stanford Medicine is providing possibilities for patients with complex heart and vessel disease while delivering exceptional outcomes.
For more information, visit the Stanford Department of Cardiothoracic Surgery and Stanford Health Care websites. For referrals or to schedule a consultation, please contact our team.
Dr. Jack Boyd
Dr. Élan Burton