Minimally invasive CABG.

For more than three decades, conventional coronary artery bypass grafting (full sternotomy, cardiopulmonary bypass, and cardioplegic arrest) has been the treatment of choice for patients with multi-vessel coronary artery disease. However, neurologic injury secondary to ascending aortic manipulation and systemic inflammatory reaction related to cardiopulmonary bypass are major causes of morbidity. During the past decade research efforts have been focused on the development of innovative revascularization techniques to minimize these deleterious effects. Minimally invasive direct coronary artery bypass surgery was developed to reduce chest trauma and to accelerate patient recovery. The relatively recent introduction of mechanical stabilizers and positioning devices has allowed for the safe performance of off-pump coronary artery bypass for patients with multi-vessel disease. Robotic technology has offered the possibility of myocardial revascularization through limited access using endoscopic principles. Recently, emphasis has been placed on the development of new sutureless anastomotic devices that may revolutionize the field of myocardial revascularization and allow a broader acceptance of minimally invasive CABG. Despite the increasing availability of new technologies, the validity of these procedures must be evaluated carefully. Prospective randomized studies and longitudinal follow-up will be required.