Perspectives of operative myocardial revascularization--minimally invasive coronary bypass--an alternative?

Minimally invasive direct coronary artery bypass surgery has evolved as a reliable method to perform left internal mammary artery (LIMA) bypass surgery to the LAD. This novel technique represents a synthesis of known approaches to coronary surgery using sternotomy without extracorporeal circulation and limited access techniques in general thoracic surgery. Applying specially designed tools for both harvesting the internal mammary artery and mechanically stabilizing the anterior surface of the heart during anastomosis, this approach is gaining widespread acceptance. A steadily growing number of patients with proximal LAD lesions are submitted to cardiac surgery and the procedure is performed with increasing success rates, now approaching 98% short term patency. Improved cosmetic results, less surgical trauma, decreased length of stay in the hospital, and comparable longterm results to open LIMA bypass to LAD are the key characteristics of this new approach to single vessel coronary disease.