Lower sternal splitting approach for off-pump coronary artery bypass grafting

There are several ways to revascularize coronary arteries without cardiopulmonary bypass using a minimally invasive method. Currently, one of the most commonly used methods is minimally invasive direct coronary artery bypass (MIDCAB) through a left thoracotomy. Using this technique, however, only the left anterior descending and diagonal branch can be grafted. This article describes coronary revascularization of the left anterior descending artery or right coronary artery, or both, via a lower ministernotomy without a transverse cut, namely, the lower sternal splitting method. Through this approach, the left anterior descending, diagonal, and right coronary arteries can be revascularized using a single, minimally invasive approach without the risk of damaging the tissue around the intercostal space when the sternum is transversely divided.