Minimally Invasive Bi-IMA OPCAB Via Left Thoracotomy

This video demonstrates a technique for performing minimally invasive, totally arterial coronary artery bypass grafting on a beating heart. The surgeons used a left-sided minithoracotomy (6-7 cm) in the fifth intercostal space. Thereafter, both internal thoracic arteries were harvested: the left one as an in situ graft and the right one to form a Y graft. The lateral and inferior surfaces of the heart were exposed using a deep pericardial stitch. Typically, the authors perform a left internal mammary artery to left anterior descending artery (LIMA-LAD) bypass and a sequential right internal mammary artery to obtuse marginal artery and posterior descending artery (RIMA-OM-PDA) bypass. This technique enables revascularization of all three coronary territories in almost any clinical situation. 

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