In the face of a technical problem with the anastomosis, we will convert the MID-CAB procedure to the conventional approach. The approach, developed by the Standford group, was originally designed to perform endoscopic coronary artery bypass surgery without an open chest incision. All basic techniques of conventional coronary artery bypass surgery are applied. Without the access provided by the sternotomy incision, the Heartport approach used femoral arterial and venous cannulation through a groin incision to institute cardiopulmonary bypass. Additional catheters are placed percutaneously through the internal jugular vein for ventricular decompression and the administration of retrograde cardioplegia.
Fluoroscopy is required for the very important and accurate placement of the catheters.
The procedure was used on two patients at Stanford with disastrous clinical outcome. Saphenous vein grafts are anastomosed to other arteries of the left heart. Proximal anastomosis are all made with the left internal mammary artery since the aorta is not accessible from the mini-incision. There are several criticisms of the Heartport approach. The only less invasive feature is the left mini-thoracotomy rather than a full stenotomy.