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Background
BITAS in CABG have shown greater survival and freedom from reintervention. Our aim was to develop a multivessel MIDCABG technique, where the RITA was directly harvested and complete revascularization of the myocardium done by OPCAB using only BITAS (LITA – RITA Y) through a 2.5” left minithoracotomy incision without any robotic or thoracoscopic assistance.

Methods
Using a 2.5” left inframammary incision the thoracic cavity was entered through the fifth intercostal space. The fatty attachments between the pericardium and the sternum were divided and on dissecting the pleura from the endothoracic fascia of the right chest wall, the RITA was visualized and directly harvested followed by the LITA. Where the RITA length was inadequate for complete revascularization, it was extended with a segment of radial artery. A LITA-RITA Y was constructed and complete revascularization of the myocardium was done followed by flow study of the grafts. We have carried out 49 cases of total arterial coronary revascularization using the left mini thoracotomy approach.

Results
We have had no mortality, recurrence of angina, myocardial infarction or any other complication during this short period of follow up.Inotropic usage was very minimal and the hospital stay was 2-3 days. Post operative Coronary angiograms done showed widely patent grafts

Conclusion
Direct harvesting of the RITA and Minimally invasive direct multivessel total arterial CABG, using BITAS as a Y conduit through a left minithoracotomy without robotic or thoracoscopic assistance and using the OPCAB technique is technically feasible and reproducible. The short term results have been excellent but a longer follow up is required.