Minimally invasive heart surgery. Executive Committee of the Council on Cardio-Thoracic and Vascular Surgery.

Abstract

Limited access or minimally invasive coronary artery surgery is being evaluated in numerous North American medical centers. The purposes of this report are to (1) describe the techniques, (2) examine progress in this new field, (3) comment on the potential of these approaches, and (4) put into perspective the expected goals of minimally invasive coronary surgery, given the proven long-term results achieved with traditional techniques (sternotomy and cardiopulmonary bypass). Minimally invasive coronary artery bypass is performed using one of two approaches: (1) a series of small holes or “ports” in the chest (referred to as PACAB, PortCAB, or port-access coronary artery bypass) or (2) a combination of ports and a small incision directly over the coronary artery to be bypassed (referred to as MIDCAB or minimally invasive coronary artery bypass). As in standard coronary artery bypass graft surgery (CABG), anesthesia is required. PACAB is currently used only by investigators at a few university centers. In this method, cardiopulmonary bypass is performed using the femoral vessels. The heart is stopped and the bypasses are performed using instruments passed through the ports, with or without a small additional chest incision. As with abdominal laparoscopic surgery, the cardiac …