Minimally invasive internal thoracic artery harvest: the hybrid approach

Background. Safe harvesting of the left internal thoracic artery is a difficult problem during minimally invasive coronary artery bypass grafting without cardiopulmonary bypass. A complete internal thoracic artery dissection through a limited approach is technically demanding and time consuming and different techniques have been proposed. Methods and Results. Based on our experience, the different surgical approaches and technical considerations are reviewed. Conclusions. A hybrid technique using dissection under direct vision and completed by thoracoscopy is discussed and proposed as our preferred technique of internal thoracic artery harvesting.