[Video-assisted coronary artery bypass]

The benefits of the internal mammary artery (IMA), as a graft, particularly for the left anterior descending (LAD) coronary artery disease, have been demonstrated. Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is now an accepted technique of myocardial revascularization. Thoracoscopy and a minimal thoracotomy have been applied to cardiac surgery, however its use has not been well defined; in our approach, we harvested the left IMA thoracoscopically. Following this the left IMA-LAD coronary artery anastomosis was fashioned, by means of a left small anterior thoracotomy on the beating heart without CPB. A double lumen endotracheal tube was used so the lung could be collapsed. Three left lateral chest ports of 1 cm were made, and the thoracoscope was placed through the initial port, permitting inspection of the thorax. The other ports were used for IMA dissection, using endoscopic instruments (electrocautery, grasping, forceps,...), the side branches were controlled by either cautery or endoscopic clips. When it was possible, the anterior port was extended doing a small left anterior thoracotomy, the pericardium was exposed, the IMA was divided and exteriorized through the thoracotomy. After coronary artery control, the bypass graft was carried out on the beating heart without CPB, in 26 patients. From september 1995 to july 1996, we have operated on 30 patients using this technique. We believe that with increasing operator experience, this minimally invasive approach will have a major impact on the management of the coronary artery disease patients, with a faster recovery, shorter hospitalization, and certainly less cost.