[Minimal access and minimally invasive coronary surgery]

After almost three decades of coronary artery surgery, there is a new interest in certain types of surgical interventions that may reduce the biological trauma through the elimination of cardiopulmonary bypass (CPB) and by practising through smaller thoracic incisions. Attempts are being made to demonstrate which operations can be performed without CPB or through minimal incisions. The operations without CPB are as old as coronary surgery itself, however they were abandoned because of the reliability and efficacy of doing coronary surgery in a bloodless and quiet field. Today a few series are already available showing that single-vessel coronary artery disease and an adequate patient selection seem to be, for the moment, fundamental issues in obtaining results as good as those obtained using conventional techniques and accesses. The main problem continues to be the quality of the anastomoses done with the heart beating or through small incisions that can make the work of the surgeon uncomfortable. Therefore, it is of utmost importance to collect postoperative angiographic data. In any case, we are in a very important moment in the history of coronary artery surgery as everybody is interested in evaluating the alternatives to reduce biological trauma by avoiding CPB and reducing the size of the incisions. These facts can have a positive influence on future results and in the reduction of the comprehensive costs of coronary artery surgery and therefore the actual impact of minimal invasive surgery.