Minimally Invasive Coronary Artery Bypass Grafting Using Bilateral In Situ Internal Thoracic Arteries

A 73-year-old male with diabetes mellitius was referred to our hospital for coronary artery bypass grafting (CABG). Preoperative coronary angiography revealed three-vessel coronary disease. Minimally invasive coronary artery grafting (MICS CABG) via left thoracotomy was selected to decrease surgical site infection due to severe diabetes. In situ bilateral internal thoracic arteries (BITA) were harvested using a long type Harmonic scalpel. In situ right internal thorac artery( RITA)-left anterior descending artery (LAD), in situ left internal thorac artery( LITA)-high lateral branch (HL), and aorta-saphenous vein graft (SVG)-#4 posterior descending artery were performed. BITA, the ascending aorta for proximal anastomosis, and all coronary targets were directly accessed with off-pump technique. There were no major postoperative complications. Postoperative 3D-computed tomography angiography (CTA) revealed all grafts were patent. We believe that use of BITA in MICS CABG is feasible, and can provide satisfactory quality. Further research however, will be needed.