Use of the ministernotomy incision for minimally invasive direct coronary artery bypass

Abstract

Minimally invasive direct coronary artery bypass (MIDCAB) is a new approach that allows selected coronary stenoses to be bypassed through a much smaller incision, either a lateral thoracotomy or a mini-sternotomy, without the aid of cardiopulmonary bypass. Generally, the internal mammary artery is used as the bypass graft, although the gastroepiploic artery or saphenous vein may also be used. The minimally invasive approach eliminates the potential complications associated with cardiopulmonary bypass. Other benefits include decreased cost, minimal postoperative discomfort, and a shortened hospital stay. Although MIDCAB is an exciting alternative to conventional coronary bypass or angioplasty procedures, this approach is currently limited mostly to patients with isolated, proximal stenoses of the left main, left anterior descending, and right coronary arteries. MIDCAB will not be suitable for widespread use until further experience is gained and additional technical refinements introduced. In this report, we describe use of the mini-sternotomy approach to MIDCAB in a 62-year-old ma and briefly summarize our total experience at the Texas Heart Institute.