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 arte ry revascularization can now be accomplished either thoracoscopically or through a small thoracotomy, sternotomy, or epigastric incision, wi th or without cardiopulmonary bypass (CPB). Methods. The current liter ature was reviewed with regard to patient selection criteria for coron ary artery bypass grafting (CABG) without CPB, indications for minimal ly invasive direct coronary artery bypass (MIDCAB), surgical and anest hetic technique, and outcome. Results. The MIDCAB is largely used in c ases of single or double vessel disease. The procedure is done either thoracoscopically or under direct vision through a small incision rath er than standard sternotomy. In non-CPB cases, the heart is pharmacolo gically manipulated to create a quiet operative field. Patients may be extubated and become ambulatory shortly after surgery and be discharg ed 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.