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Mid Cab began in the 1960s with Vassili Kolessove a brilliant Russian surgeon who was the first to anastomose a left internal thoracic artery to the left anterior descending artery (LAD).The surgical approach was left anterior thoracotomy ,who ever has the opportunity to read his paper (1) will be impressed by his surgical technique ,which is identical to what is done to day (incision at the 5th intercostal space and the harvesting the thoracic artery up to the 2nd intercostal space).He also described left anterior descending artery precondtioning and post operative spasm,which was treated with oral nitroglycerine.He used interrupted sutures,with an anastomotic time 6 minutes.
Unfortunately the scientific world did not trust this innovative surgeon.The editors forward to his paper was the following :"The opinion concerning the management and treatment of angina pectoris as expressed in this paper by professor V.I.Kolessove are at variance with the concepts of many surgeons in the United States--(Brian Blades)
This procedure remained obsolete for years .In 1994 Federico Benetti using thoracoscope reported the same procedure .
Indications for MID CAB(minimally invasive):
Surgical indications:The patients with an isolated LAD (left Anterior descending artery)or right coronary lesion or with lesions of both arteries in whom PTCA ( percutaneous coronary angioplasty ) is not advisable due to complex stenosis .
Arrow points to the LAD (main artery supplying blood to the front of the heart) with serious stenosis,requiring MIDCAB.
Anatomical indications :the distal LAD must be at least 1.5mm. and not calcified .If an intramyocardial course is certain at angiography this is an absolute contraindication. Surgical approach : Mid CAB or LAST (Lateral anterior small thoracotomy)like any other operation ,requires adequate exposure 6-10 cm incision is used regardless of the type and location .Different methods of access have been used : Ant.lt/rt thoracotomy ,partial sternotomy,parasternal thoracotomy and upper mid line.Lt thoracotomy incision is the most commonly used incision at present time to approach the proximal Lad lesions >the 4th or 5th intercostal space is entered.
Limitation of this technique .At the present time ,application of minimally invasive cabg is possible only for limited disease and is mainly done with LIMA to the LAD,Diagnol coronary arteries.
Arrow points to the LAD (main artery supplying blood to the front of the heart) with serious stenosis,requiring MIDCAB.