Bilateral MIDCAB for triple vessel coronary disease.

Minimally invasive direct coronary artery bypass grafting utilising an anterior mini-thoracotomy has traditionally been limited to surgical revascularisation for single or double vessel coronary disease. The widespread use of percutaneous coronary intervention has further limited the use of this technique. Minimally invasive direct coronary artery bypass grafting offers the advantage of avoiding a sternotomy, in patients with a higher risk of sternal wound dehiscence and infection. We have used bilateral anterior mini-thoracotomy in conjunction with bilateral internal mammary and radial artery conduits, allowing an aortic no-touch technique, on the off-pump heart in two patients.