Totally endoscopic coronary artery bypass grafting on the arrested heart.

In the late 1990s, totally endoscopic coronary artery bypass grafting was successfully introduced into the heart surgery armamentarium using robotic techniques. Surgeons have applied the da Vinci telemanipulation system in order to develop completely endoscopic placement of internal mammary artery bypass grafts, mainly to the left anterior descending artery system. Multivessel procedures are currently under development. These operations can be carried out on the arrested heart using remote access perfusion and cardioplegic arrest via ascending aortic balloon occlusion. Another option is performing procedures on the beating heart using an endostablilizer and local coronary artery occlusion. In this review, the technique and specific aspects of the arrested heart version of totally endoscopic coronary artery bypass grafting are outlined.