Minimally invasive coronary artery bypass grafting: is it time for the robot?
OBJECTIVE
Minimally invasive coronary artery bypass grafting (MICS CABG) consists of single-vessel or multivessel revascularization via a small left thoracotomy, and has been proposed as an alternative to a standard sternotomy approach. The purpose of this article is to examine the current status of MICS CABG and discuss its future directions.


RESULTS
Experience in the first 450 cases was reported in 2009, and established the efficacy and safety of a small thoracotomy approach for multivessel and single-vessel revascularization. In addition to earlier recovery and rehabilitation, MICS CABG is associated with fewer transfusions and fewer wound infections than off-pump CABG. Recently, the MICS CABG Patency Study showed excellent graft patency in patients assessed by 64-slice computed tomography angiography 6 months after operation. We also showed that the use of cardiopulmonary bypass assistance may help alleviate some of the learning curve inherent in this operation.


CONCLUSIONS
MICS CABG has developed into a reproducible, high-quality, complete surgical revascularization alternative to conventional CABG. Preservation of sternal integrity allows patients to recover earlier, require fewer transfusions, and experience fewer infections. Further research on expanding the applicability of MICS CABG and enhancing its advantages over conventional CABG is warranted.
aDivision of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada bDepartment of Cardiothoracic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates cCardiothoracic Department, Staten Island University Hospital, New York, USA.
Marc
M
Ruel
Dai
D
Une
Johannes
J
Bonatti
Joseph T
JT
McGinn
D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome