INSTRUMENTATION FOR MINIMALLY INVASIVE INTERNAL THORACIC ARTERY HARVEST

The anterior fourth interspace minithoracotomy is our current choice f or exposure of the anterior myocardial wall for minimally invasive cor onary bypass grafting procedures. This approach provides direct access to the left anterior descending coronary artery for anastomosis, and good exposure of the midsegment of the internal thoracic artery. We de scribe the use of instrumentation that facilitates the harvest of the left internal thoracic artery under direct vision. The use of this ret ractor system, which elevates the third and fourth and depresses the s econd and first ribs, permits better visualization of the internal tho racic artery and allows for proximal internal thoracic artery harvest without rib resection. (C) 1997 by The Society of Thoracic Surgeons.