[Video-assisted MICABG for the patient with right mammary carcinoma--a case report]

A 69-year-old female with advanced right mammary carcinoma presented to us with diffuse stenosis of the proxymal left anterior descending artery (LAD). Right mastectomy had been suspended. The LAD was treated with minimally invasive CABG (MICABG) assisted with a thoracoscopic procedure. The left internal thoracic artery (LITA) was taken down through thoracoscopy from the upper margin of the 1st rib to the lower margin of the 5th rib using only the Harmonic Scalpel (Ethicon Endo-Surgery). Coronary anastomosis to the LAD was completed without cardiopulmonary bypass through a small thoracotomy on the anterior 4th intercostal space. The operation time was 4 h 30 min and the blood loss was 120 ml. Post operative course was uneventful. Doppler study and angiography demonstrated patent LITA to the LAD. Right mastectomy was achieved 29 days after MICABG. MICABG can be a veneficial alternative method for the patient with malignant disease, allowing quick convalescence and early cancer operation. Thoracoscopy allows for sufficient LITA harvest up to the 1st rib or higher with the Harmonic Scalpel.