Harvesting of distal left internal thoracic artery through anterior thoracotomy: surgical technique and case report

The main surgical access for minimally invasive direct coronary artery bypass (MIDCAB) procedure is anterior thoracotomy in the IV intercostal space. This surgical access is used for harvesting of the left internal thoracic artery, opening the pericardial cavity and imposing the anastomosis between internal thoracic artery and left anterior descending artery. At the same time, it is difficult to harvest distal segment of this artery via thoracotomy in the IV intercostal space due to impossible adequate traction of the V and VI ribs and, as a consequence, impossible adequate visualization of appropriate area for surgical manipulations. The purpose of this report was to develop surgical technique for harvesting of distal segment of the left internal thoracic artery via anterior thoracotomy.