title: Minimally invasive direct coronary artery bypass grafting with an improved rib spreader and a new-shaped cardiac stabilizer: results of 200 consecutive cases in a single institution.
abstract: BACKGROUND
  Performing minimally invasive direct coronary artery bypass (MIDCAB) grafting via small chest incisions on a beating heart is challenging. We report our experiences of MIDCAB with the utilization of both an improved rib spreader to harvest the left internal mammary artery (LIMA) and a new-shaped cardiac stabilizer to facilitate LIMA-left anterior descending (LAD) coronary anastomosis.
  
  
  METHODS
  Between May 2012 and June 2104, a total of 200 patients who were consecutively operated on in this period were enrolled in this study. Data reported included demographic information, preoperative clinical and cardiac status, LIMA harvest time, postoperative in-hospital outcomes, and 30-day mortality.
  
  
  RESULTS
  The average LIMA harvest time was 43 min. The mean age was 62.59 ± 10.19 years, and 45 of the 200 were females. The 30-day mortality was 0.5% (one patient) due to perioperative myocardial infarction. Duration of mechanical ventilation and length of stay in intensive care unit was 9.27 ± 7.65 and 24.27 ± 17.85 h, respectively. The unit of packed RBC transfusion was 0.79 ± 1.58. Postoperative atrial fibrillation was observed in 14 (7%) patients. There was no postoperative stroke, renal failure, or incision complication.
  
  
  CONCLUSIONS
  Performing MIDCAB with the improved retractor and stabilizer utilized in this study showed favorable outcomes in terms of harvesting the LIMA, postoperative morbidities, and 30-day mortality.
authors.affiliation: Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China. micsling@163.com.
authors.forename: Yunpeng
authors.initials: Y
authors.lastname: Ling
authors.affiliation: Department of Cardiac Surgery, Aero Space Center Hospital, Beijing, China. baoliming_blm@alyun.com.
authors.forename: Liming
authors.initials: L
authors.lastname: Bao
authors.affiliation: Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China. joeyw77@139.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China. yu_chen12@hotmail.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China. cobra_gq@hotmail.com.
authors.forename: Qing
authors.initials: Q
authors.lastname: Gao
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000295:instrumentation / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation* / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D011183:Postoperative Complications; D013525:Surgical Instruments; D016896:Treatment Outcome