Current status of minimally invasive, robotic and hybrid coronary artery bypass surgery

Abstract

While coronary artery bypass graft (CABG) remains the gold standard in the treatment of multivessel coronary artery disease, it remains quite invasive. Techniques and evolving technologies of minimally invasive (including hybrid and robotic) approaches to coronary revascularization are reviewed in this chapter with a summary of the available supporting literature. Minimally invasive direct coronary bypass (MIDCAB) surgery uses an anterior, medially placed, mini-thoracotomy incision for both direct-vision left internal mammary (LIMA) harvest and creation of an anastomosis of the LIMA to a coronary artery in off-pump fashion. As in standard CABG, all patients should undergo a complete preoperative work-up, and body mass index and body habitus are to be noted. Obesity is considered a relative contraindication for MIDCAB as it may predispose to wound infection; this concern is primarily due to tissue necrosis caused by pressure on the wound edges by the retractor during LIMA harvest.