[MSB-71] Optimizing Total Coronary Revascularization: Exploring Total Coronary Revascularization with Anterior Thoracotomy Access Via Third vs. Fourth Intercostal Space in Coronary Artery Bypass Graft Surgery

Total coronary revascularization with right anterior thoracotomy for CABG surgery is feasible and effective when accessed through either the third or fourth intercostal space. The fourth intercostal space may provide slightly better visualization for the distal part of LIMA, a longer LIMA graft, and lesser rib fracture, leading to lesser postoperative pain. On the other hand, the third intercostal space is best for proximal LIMA harvesting with lesser LIMA injury without the need for CPB initiation for proximal LIMA harvesting. Surgeon preference, patient anatomy, and procedural considerations should guide the choice of intercostal space for TCRAT implementation in CABG.