MIDCAB procedure

The MIDCAB procedure (minimally invasi­ve direct coronary artery bypass) is also performed occasionally, with access through a left anterolateral minithoracotomy. The MIDCAB technique (using the Octopus system) is very similar in principle to the OPCAB technique as regards stabilisation of the operation field on the beating heart. While the entire heart is exposed through a midline sternotomy in OPCAB, a ca. 5 - 7 cm anterolateral minithoracotomy (left-sided submammary incision, 4th or 5th intercostal space, illustration left) is performed under intubation anaesthesia in the MIDCAP technique. The left internal mammary artery (LIMA) is dissected under direct vision using special thoracic retractors. The heart surface is stabilised along the course of the left anterior descending artery (LAD) by a pressure stabiliser, thus allowing the surgeon to occlude the LAD while the LIMA-LAD anastomosis is constructed in about 6 - 10 min. Intensive perioperative anaesthesiological monitoring is essential during beating heart surgery. Apart from the usual haemodynamic measurements, transoesophageal echocardiography is performed routinely in our clinic in order to detect regional or global contraction disorders immediately.