Some Thoughts on Minimally Invasive Coronary Bypass

Abstract

With the advent of minimally invasive and off-pump coronary artery bypass grafting (CABG), cardiac surgery has reached a “strategic inflexion point” at which alternate pathways offer both dangers and opportunities that may lead to increased success or dismal failure. Since the price of a cardiac surgeon’s misjudgment is ultimately paid by the patient, at critical junctures it is vital to maintain our profession’s tradition of vigorous discussion and debate about new technologies. Most of my comments will be about off-pump coronary artery bypass (OPCAB) because avoidance of the pump seems a worthwhile goal. In contrast, with current technology, the complexity and risk of port-access coronary bypass with the pump seem to outweigh the benefit of merely avoiding a sternotomy. This view may change as we improve port-access techniques but I know from personal experience that sternotomy incisions are not so bad. Furthermore, portaccess CABG is done in relatively few centers compared with off-pump CABG.