Minimally invasive coronary artery bypass grafting: is it time for the robot?

Purpose of reviewMinimally 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.Recent findingsExperience 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.SummaryMICS 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.