The 10 Commandments of Less Invasive CABG: How to Increase Adoption

Coronary artery bypass grafting (CABG) is one of the most performed operations worldwide. However, CABG is often as invasive today as it was 50 years ago. Less invasive CABG, or minimally invasive CABG (MICS CABG), can take many forms. Regardless of which iteration is undertaken, less invasive CABG represents one of the most technically challenging operations that a cardiac surgeon can perform today. Indeed, through a small incision, reconstructive microsurgery must be performed flawlessly, with different exposures for the harvesting of each conduit, the sourcing of inflows, and the grafting of every myocardial territory. If MICS CABG were to fail, consequences can be ominous—since alternatives such as percutaneous intervention and conventional CABG have long demonstrated their reliability, despite their shortcomings. It is germane for our patients and for the field that centers of excellence in coronary artery surgery dedicate resources and expertise to developing safe, high-quality, reproducible, and durable forms of less invasive CABG. This article, in the format of “10 Commandments of Less Invasive CABG,” proposes a stepwise path for the safe uptake of MICS CABG, toward increasing its adoption in one or several of its forms.