Minimally Invasive Goronary Artery Bypass Grafting

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Abstract
Minimally invasive coronary artery bypass grafting (CABG) without cardiopulmonary bypass is a useful option for selected patients with isolated proximal stenoses of the left anterior descending. (LAD) or right coronary artely (RCA), or with recurrent stenosis after conventional CABG (with cardiopulmonary bypass), angioplasty or stenting, particularly in elderly patients and those the with major comorbidities making cardiopulmonary bypass too risky. Benefits of minimally invasive CABG include a smaller skin inciosion, shorter operating time, fewer arrhythmias, less blood loss, a shorter hospital stay, and lower cost. Multivessel disease can be treated with a staged, hybrid approach integrating minimally invasive CABG and transcatheter interventions. As new mechanical stabilizing deveises become available for local immobilization of the myocardium during operations on the beating heart, minimally invasive CABG can be extended to lesions involving coronary branches on the posterolateral surface of the heart that are difficult to access. Although minimally invasive CABG id an exciting alternative to transcatheter interventions or concentional CABG with cardiopulmonary bypass in selected cases it is technically more challenging and the long-term results are unknown. Therefore interventions, widespread use is unjustified. Because of the high rest enosis rate after transcatheter interventions, conventional CABG is still believed to offer a more durable treatment for coronary aetery disease. Witb refinements and reduction in the stenosis rate, stenting can become increasingly competitive with minimally invasice CABG as a less invasive technique of myocardial revascularization. Some centers use port access and video assistance to aid minimally invasive procedures. Videp-assisted robotic surgery is still in an experimental stage.

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