Quintuple Arterial Minimally Invasive Coronary Artery Bypass Grafting: Non-touch Aortic Technique

Minimally invasive coronary surgery has numerous benefits over conventional coronary surgery through sternotomy. Patients have less surgical trauma to tissue, a shorter stay in the hospital, and a better quality of life after the operation. In the presented surgical technique, minimally invasive cardiac surgery (MICS)-coronary artery bypass graft surgery (CABG), we achieved total arterial revascularization of the myocardium with five bypasses, off-pump, without manipulation of the aorta. Using left thoracotomy, the left internal mammary artery was harvested, and from the non-dominant hand, the radial artery (AR) was harvested with the no-touch technique. A composite T-graft was created with the left intrathoracic mammary artery (LIMA) and the AR. Then, the LIMA was used as a sequential graft to a diagonal (Dg) branch, and the distal LIMA was used for a termino-lateral (T-L) anastomosis between the LIMA and the left anterior descending artery (LAD). The AR was used for grafting obtuse marginal (OM) branches (first OM (OM1), second OM (OM2)) and the posterior descending artery (PDA), as a LIMA-AR-OM1-OM2-PDA graft, jumping anastomosis. The patient was discharged from the hospital on the fourth postoperative day, and after three months, a control computed tomography (CT) coronary angiography confirmed optimal graft patency. This surgical technique highlights the feasibility and benefits of total arterial, off-pump, non-touch aorta surgical revascularization, reducing the perioperative risk and promoting better functional recovery.