title: Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients.
abstract: BACKGROUND
  Minimally invasive coronary artery bypass grafting (MICS CABG) is a novel coronary operation that does not require infrastructure and is potentially available to all cardiac surgeons. It aims at decreasing the invasiveness of conventional CABG while preserving the applicability and durability of surgical revascularization. We examined the feasibility and safety of MICS CABG in the first large series of this operation to date.
  
  
  RESULTS
  All myocardial territories are accessed via a 4- to 6-cm left fifth intercostal thoracotomy. An apical positioner and epicardial stabilizer are introduced into the chest through the subxyphoid and left seventh intercostal spaces, respectively. The left internal thoracic artery is used to graft the left anterior descending artery, and radial artery or saphenous vein segments are used to graft the lateral and inferior myocardial territories. Proximal anastomoses are performed directly onto the aorta or from the left internal thoracic artery as a T-graft. In the first 450 consecutive MICS CABG procedures at our 2 centers, mean+/-SD age was 62.3+/-10.7 years and 123 patients were female (27%). The average number of grafts was 2.1+/-0.7, with complete revascularization in 95% of patients. There were 34 patients in whom cardiopulmonary bypass was used (7.6%), 17 conversions to sternotomy (3.8%), and 10 reinterventions for bleeding (2.2%). Perioperative mortality occurred in 6 patients (1.3%).
  
  
  CONCLUSIONS
  MICS CABG is feasible and has excellent procedural and short-term outcomes. This operation could potentially make multivessel minimally invasive coronary surgery safe, effective, and more widely available.
authors.affiliation: Department of Cardiothoracic Surgery, Staten Island University Hospital, NY 10305, USA. jmcginn@siuh.edu
authors.forename: Joseph T
authors.initials: JT
authors.lastname: McGinn
authors.forename: Saif
authors.initials: S
authors.lastname: Usman
authors.forename: Harry
authors.initials: H
authors.lastname: Lapierre
authors.forename: Vijayasimha R
authors.initials: VR
authors.lastname: Pothula
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Mesana
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection