Subxiphoid (sternal sparing) approach for minimal access coronary artery bypass grafting

Background Coronary artery bypass grafting (CABG) is one of the commonest cardiothoracic surgical procedures carried out in today's day and age. Traditionally, the midline sternotomy approach was in vogue, and CABG would be done on cardiopulmonary bypass. With further advances and expertise, various procedural modifications have been made including off-pump CABG and minimally access procedures which include minimally invasive direct coronary artery bypass (MIDCAB) grafting and partial sternotomy techniques. Subxiphoid CABG is a sparingly used novel approach but nonetheless an excellent choice in many cases. Objective To study the feasibility of minimal access subxiphoid CABG and its outcomes in patients. Materials and methods We used the subxiphoid approach in seven cases from June 2014 to date. Patients were followed up prospectively and evaluated for various factors which included post-op pain scores, healing and graft patency. Results This technique is very useful and has various advantages. Blood loss was found to be less. Healing was found to be faster and hospital stay comparably shorter. Conclusion The subxiphoid approach for CABG is a novel advancement in this surgery and is a true minimal access procedure which includes doing the CABG through a small incision, just starting below the xiphisternum and extending below to less than 3 inches. Direct CABG is done through this approach including multivessel grafting and gastroepiploic artery harvesting. We hereby would like to describe this advancement in the field of cardiac surgery.