Minimally Invasive Coronary Artery Bypass Grafting (MIS CABG)

Abstract

Coronary artery bypass grafting (CABG) is the gold standard for the definitive treatment of coronary disease. With the advent of percutaneous transluminal angioplasty, cardiac surgery fell behind which made surgeons leave their comfort zone and search for new surgical techniques in order to obtain, with smaller incisions, similar results to those of conventional surgery and better postoperative evolution, culminating in the so called minimally invasive surgery. Minimally invasive coronary bypass is defined as any procedure performed without the aid of cardiopulmonary bypass (CPB) and/or through a minimal access approach (that is, non median sternotomy). There are several new directions being pursued in minimally invasive cardiac surgery, including using smaller or more directed "limited incisions" to access and repair only the area of interest on the heart. Coronary grafting is also now being done off pump without the hemodynamic support of CPB or the "still heart" achieved by using cardioplegia. Conduits for bypass grafting are being harvested in Summary 111 a less invasive fashion, and robotic technology is now allowing some cardiac surgery to be done solely through intercostals trocar ports. Minimally Invasive CABG being done mainly as an off pump technique avoids the hazards of the cardiopulmonary bypass including the acute and chronic endothelial injury, coagulopathy and the systemic inflammatory response. The additional benefits noted include a shortened hospital stay, less blood loss and homologous blood product administration, decreased hospital costs, and a reduction in the neurologic sequelae and the incidence of postoperative atrial fibrillation.