Reducing cardiac surgical trauma: the minimally invasive direct coronary artery bypass.

Background: The concept of minimal surgical trauma is revolutionizing many surgical subspecialties, including cardiac surgery. Coronary artery revascularization can now be accomplished either thoracoscopically or through a small thoracotomy, sternotomy, or epigastric incision, with or without cardiopulmonary bypass (CPB).

Methods: The current literature was reviewed with regard to patient selection criteria for coronary artery bypass grafting (CABG) without CPB, indications for minimally invasive direct coronary artery bypass (MIDCAB), surgical and anesthetic technique, and outcome.

Results: The MIDCAB is largely used in cases of single or double vessel disease. The procedure is done either thoracoscopically or under direct vision through a small incision rather than standard sternotomy. In non-CPB cases, the heart is pharmacologically manipulated to create a quiet operative field. Patients may be extubated and become ambulatory shortly after surgery and be discharged within a few days.

Conclusions: The MIDCAB avoids median sternotomy and, in many cases, CPB. MIDCAB may prove to play a prominent role in management of coronary artery disease in the future.