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Minimally invasive direct coronary artery bypass (MIDCAB) grafting

Minimally invasive direct coronary artery bypass (MIDCAB) grafting is the technique to achieve revascularization of the anterior wall of the left ventricle using the left internal mammary artery (LIMA) as the bypass graft to the left anterior descending (LAD) artery. The procedure performed through a left anterior mini thoracotomy has been proposed as a less invasive alternative to full sternotomy revascularization in isolated LAD disease. It is most commonly performed when percutaneous coronary intervention (PCI) is not advisable (complex proximal lesions), not successful, or not possible (occluded LAD). It is also an option for patients who have previously undergone PCI of the LAD and have recurrence of symptoms due to development of in-stent stenosis. The procedure is limited by a steep learning curve. Despite its technically demanding nature, it is associated with low postoperative mortality and morbidity especially when performed regularly by experienced surgeons in high-volume centres. It is increasingly being offered in the setting of hybrid revascularization. This narrative review provides an overview of the history, indications, contraindications, technical aspects, and outcomes of MIDCAB.