Minimally Invasive Coronary Artery Bypass Grafting: A Review

Minimally invasive coronary artery bypass grafting (CABG) without cardiopulmonary bypass is a useful option for selected patients with isolated, proximal stenoses of the left anterior descending (LAD) or right coronary artery (RCA), or with recurrent stenosis after conventional CABG (with cardiopulmonary bypass), angioplasty, or stenting, particularly in elderly patients and those with major comorbidities making cardiopulmonary bypass too risky. Benefits of minimally invasive CABG include a smaller skin incision, shorter operating time, fewer arrhythmias, less blood loss, a shorter hospital stay, and lower cost. Multivessel disease can be treated with a staged, hybrid approach integrating minimally invasive CABG and transcatheter interventions. As new mechanical stabilizing devices become available for local immobilization of the myocardium during operations on the beating heart, minimally invasive CABG can be extended to lesions involving coronary branches on the posterolateral surface of the heart that are difficult to access. Although minimally invasive CABG is an exciting alternative to transcatheter interventions or conventional CABG with cardiopulmonary bypass in selected cases, it is technically more challenging, and the long-term results are unknown. Therefore, indiscriminate widespread use is unjustified. Because of the high restenosis rate after transcatheter interventions, conventional CABG is still believed to offer a more durable treatment for coronary artery disease. With refinements and reduction in the stenosis rate, stenting can become increasingly competitive with minimally invasive CABG as a less invasive technique of myocardial revascularization. Some centers use port access and video assistance to aid minimally invasive procedures. Video-assisted robotic surgery is still in an experimental stage.