Minimally invasive coronary artery bypass grafting

Abstract

Minimally invasive coronary artery bypass grafting combines the long-term effectiveness of conventional coronary artery bypass grafting while reducing the morbidity by avoiding a median sternotomy incision or avoiding cardiopulmonary bypass or both. For single vessel coronary artery disease, minimally invasive coronary artery bypass grafting or MIDCAB has become widely accepted as a standard procedure. Excellent patency rates comparable to those of conventional surgery can be obtained especially when stablization instruments are used. However, one must be cautious as such results are not uniformly reproducible. Another concept called port-access is to avoid the median sternotomy by using peripheral cannulation for establishing cardiopulmonary bypass and performing the rest of the surgical procedure through small incisions. Excellent patency rates have been reported; however, the disadvantages of a port-access system are that it is a more complex procedure, requires trained staff, and has potentially higher costs than conventional coronary artery bypass grafting. Although encouraging results have been reported using minimally invasive techniques for coronary artery bypass grafting, more widespread and universal application of these techniques await confirmation that these results are easily reproducible.