Abstract
THE TECHNIQUE OF minimally invasive direct coronary artery bypass (MIDCAB) has been extensively modified since 1995; at present, the procedure has evolved significantly and is referred to as endoscopic atraumatic coronary artery bypass grafting (Endo ACAB). In this procedure, the left internal mammary artery (LIMA) is harvested, and identification of the left anterior descending (LAD) artery is performed endoscopically with robotic assistance. The MIDCAB is then performed through a smaller incision that directly overlies the LAD. The learning experience continues, and there is constant improvement in the tools used. Many of the modifications have been made to overcome technical difficulties associated with port-access harvesting of the LIMA and endoscopic stabilization of the LAD, and although the Endo ACAB is performed without cardiopulmonary bypass (CPB) like the off-pump coronary artery bypass (OPCAB) procedure, there are many differences in the anesthetic management of these patients. The purpose of this article is to help accelerate the learning curve of this procedure.
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