A modified thoracotomy for minimally invasive coronary artery bypass grafting

The optimal technique of minimally invasive coronary artery revascularization using the in situ internal thoracic artery (ITA), without extracorporeal circulation, is yet to be defined. To obtain adequate exposure for both ITA harvest and left anterior descending coronary artery anastomosis, an anterior chest wall defect is created which can be difficult to reconstruct. Based on the vascular anatomy of the acromiothoracic axis and three described osteocutaneous composite tissue flaps, we present a novel dissection that not only improves exposure, but also preserves chest wall integrity.