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Minimally invasive coronary artery bypass graft surgery: Definitions and technical issues

Gabriel S Aldea, MD
Section Editors
Edward Verrier, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
Gordon M Saperia, MD, FACC


Less invasive surgical techniques using laparoscopy and robotics through smaller incisions with specialized instruments have been applied to many abdominal, urologic, and gynecologic procedures. These alternative approaches are safe and effective, resulting in a reduction in patient discomfort and hospital length of stay and cost.

There is increasing experience with the use of similar techniques to open cardiac surgery. The definitions and technical issues related to minimally invasive coronary artery bypass graft surgery (CABG) will be reviewed here. The clinical outcomes with these procedures and minimally invasive approaches to valvular surgery are discussed separately. (See "Off-pump and minimally invasive direct coronary artery bypass graft surgery: Outcomes" and "Minimally invasive aortic and mitral valve surgery".)

To appreciate the potential value of minimally invasive CABG, it is useful to first review the complications associated with standard CABG.


Coronary artery bypass grafting (CABG), especially with the use of the left internal thoracic (mammary) artery to the left anterior descending artery (LAD) relieves symptoms, improves survival, and decreases recurrence of adverse cardiovascular events in selected groups of patients. Durability and survival are further enhanced by the use of more complete arterial revascularization [1,2]. The alternative in patients who need revascularization is percutaneous coronary intervention (PCI), which is now usually performed with implantation of drug-eluting stents (DES). (See "Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention" and "Coronary artery bypass graft surgery: Causes and rates of graft failure".)

The main advantages of CABG over PCI with DES are a lower rate of revascularization, correction of all coronary lesions including those that cannot easily or adequately be treated with PCI (such as chronic total occlusions and very long diffusely diseased lesions), and, in selected patients (particularly individuals with diabetes and patients with high Syntax scores), a reduction in myocardial infarction and long-term mortality. This benefit may be extended to nondiabetic patients with intermediate and high SYNTAX score [3-5]. The main disadvantage of CABG compared with PCI is its real and perceived invasiveness with its attendant longer initial recovery period (typically four to six weeks). Compared with PCI, the quality of life is similar if not superior for patients undergoing conventional CABG by one year [6-8].(See "Coronary artery revascularization in patients with diabetes mellitus and multivessel coronary artery disease" and "Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 07, 2016.
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