Concomitant surgery of minimally invasive direct coronary artery bypass with left atrium appendage closure

Surgical approaches of minimally invasive direct coronary artery bypass and left atrial appendage exclusion are different, and issues may arise in cases of concomitant surgery. Moreover, the safety of concomitant procedures has not been established. A man in his 80s with a history of stroke required minimally invasive coronary artery bypass grafting and left atrial appendage closure for the stenosis of the left anterior descending artery and atrial fibrillation. He suffered from bladder bleeding, which required early reduction of anticoagulant and antiplatelet medication. Therefore, he wished for surgical treatment. A lateral incision was necessary for left atrial appendage closure in minimally invasive surgery. We performed totally endoscopic harvest of the internal thoracic artery without a robotic system. This method allowed the incision to be made more laterally. Combining the endoscopic harvest of the internal mammary artery with left atrial appendage closure via lateral incision may be a reasonable technique.