[Lower-end sternal splitting (LESS) approach as a new strategy for minimally invasive off-pump CABG]

There are several ways to perform off-pump coronary artery bypass grafting (OPCAB) using a minimally invasive method. Currently, one of the most commonly used approaches is left anterior small thoracotomy (LAST). However, using this approach, only the LAD can be grafted. We have employed a partial sternotomy without a transverse cut, namely, the lower-end sternal splitting (LESS) approach for OPCAB. Through this approach, the LAD and RCA can be revascularized via a single small incision without the risk of damaging the tissue around the intercostal space when the sternum is transversely divided. Since November 1999 to September 2000, we have applied OPCAB through LESS approach in 17 patients. Mean age was 70.0 + 5.4 years (range 58-77), and 13 were men. Mean length of the skin incision was 8.6 + 1.2 cm (range 8-11). No hospital death or morbidity was observed. No patient required blood transfusion. All had arterial conduits: LITA-LAD, in 11; LITA-LAD, RITA-RCA, in 1; LITA-LAD, GEA-PDA, in 2; LITA-LAD, RITA-RCA, RITA-RA-PDA, in 1; and GEA-PDA, in 2. All underwent postoperative coronary angiography, and the patency rate was 95.5%. Our experience demonstrates that the LESS approach for OPCAB is technically feasible and can be used with excellent cosmetic results and safety. Although experience is limited, this less invasive surgical technique can be used as an alternative approach for MIDCAB in patients with LAD and/or RCA disease.