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Minimally invasive off pump CABG technique using "LIMA to LAD" first in staged hybrid approach for complex Coronary artery disease


Best solution to solve ideal revascularisation remains a dilemma for complex Coronary artery disease. However, emerging minimally invasive off pump CABG technique can provided optimum solution for this condition.


To evaluate significance of Minimally invasive CABG using " LIMA to LAD first " in staged hybrid approach in patients with complex Coronary artery disease with compromised LV function and associated co morbid conditions.


Between December 2012 and 2014 total 28 patients were taken up for Surgery using off pump MIDCAB and MICS CABG technique. LIMA was harvested in all cases using harmonic scalpel and target LAD grafting was done using polypropylene 7-0 or 8 - 0 depending on luminal size and quality of LIMA. All patients were evaluated with preoperative risk stratification and standard work up protocol including consent to convert in sternotomy, on pump or any other life support system in demand.


Out of 28 patients, 27 (97%) had successful LIMA to LAD grafting achieved. All patients were operated off pump method.

Relief in angina was observed in 60 per sent cases. Nine patients (30 %) underwent staged PCI after six months of the CABG. They also had smooth course and improved outcome during and after the intervention.


Using current Minimally invasive off pump CABG technique with staged hybrid PCI option for non - LAD lesions, complex Coronary artery lesion can be efficiently managed by the heart team with better outcomes in short term. In addition,this procedure may provide safe and cohesive environment for the Surgeons and intervention cardiologists to work together for best interest of the patients.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Joshi, L.M., Tewari, B.C., Vijay, S.K. et al. Minimally invasive off pump CABG technique using "LIMA to LAD" first in staged hybrid approach for complex Coronary artery disease. J Cardiothorac Surg 10 (Suppl 1), A119 (2015).

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