For nearly 60 years heart bypass surgery has been done by splitting the breastbone, but a less invasive approach pioneered by Marc Ruel, a cardiac surgeon at the University of Ottawa Heart Institute, helps speed up patient recovery, according to new research.

Patients who have the surgery performed through a small incision between the ribs, reported an easier recovery one month postoperation, along with other benefits, a study published Friday in The Lancet medical journal found.

The study detailed the findings of the first randomized controlled trial comparing the two methods for multivessel bypass surgery. Dr. Ruel, a world-renowned heart surgeon and the lead author, said the newer approach allows patients to get back to their normal lives faster.

“We’ve been perfecting bypass surgery for almost 60 years. People ask ‘Why change the way that it’s done when it works well?’ Well, because it’s too invasive,” Dr. Ruel said.

“Making a breastbone incision serves the surgeon for sure, there’s no question, but it doesn’t optimally serve the patient. And there are ways that the surgeon can still do a perfect job, yet the patient be served better. That’s what we’ve shown.”

Coronary artery bypass graft surgery, which helps restore blood flow to areas of the heart, is the most common type of bypass surgery performed in Canada with an estimated 25,000 procedures annually.

The study’s findings could influence cardiac care worldwide, Dr. Ruel said.

Other advantages to the newer method include a shorter total ventilation time and fewer blood transfusions than the conventional method, known as a median sternotomy, a surgical cut down the middle of the chest through the breastbone.

At the one-year mark, there were no deaths or strokes recorded in either group and other serious adverse side effects were infrequent across the board.

Until the new study, evidence supporting the nonsternotomy approach was scarce save for non-randomized studies at single centres. And Dr. Ruel said many surgeons were skeptical of the technique.

This is despite known drawbacks of the standard approach, including a delayed return to full physical activity, chronic pain, the risk of infections and the breastbone healing incorrectly, the authors noted.

The study addresses concerns, which have tempered wider adoption of the procedure, according to the researchers. It demonstrates that avoiding a sternotomy can improve patient recovery at the one-month mark “while showing no apparent reduction in procedural quality or safety through to 12 months.”

In total, 170 patients were part of the trial between August, 2018, and November, 2024, at seven centres across six countries: Canada, India, China, Germany, Japan and the United States. Most of the participants were male with a median age of 67.

Dr. Ruel said there will need to be widespread training on the technique.

“My next job is going to be to teach this to young surgeons around the globe,” Dr. Ruel said, adding that more than 150 teams have already visited Ottawa to learn how to perform this operation and bring it back to their respective countries.

“We never want to be considering the patient as a guinea pig. If we bring innovation, it’s absolutely essential you do it safely and effectively,” he said.

Dr. Ruel performed his first nonsternotomy bypass surgery in September, 2005, on a three-vessel bypass patient from Gatineau. He is now nearing 1,000 surgeries of this kind with successful outcomes.

Authors noted that the underrepresentation of women was a limitation of the study, “which might reflect perceived technical challenges related to anatomical factors.” They said growing experience in this method may address this perceived barrier.

Dr. Ruel said there are less women who receive treatment for heart disease compared to men, which added to the difficulty in recruiting women.

He also said it is more challenging to perform the surgery on women with larger breasts or implants but, in his practice, said women have responded “extremely well” to the less invasive approach.

The study’s authors said the results of their trial may inform future studies evaluating less invasive surgical techniques in women, “for whom the effect of surgical invasiveness on recovery and outcomes remains inadequately studied.”

Patients enrolled in the trial are being followed for five years, which will provide insight into long-term outcomes.