Bailouts to LIMA Damage for Avoiding Conversion in Minimal Access Coronary Procedures

Minimally invasive and robotic coronary revascularization strategies offer less pain, fewer adverse events, better cosmesis, and speedier recovery. These procedures are vulnerable to left internal mammary artery (LIMA) injury that may require a full sternotomy, which eliminates the benefits of minimally invasive procedures. We present a management protocol to avoid conversion to sternotomy in minimally invasive cases based on the location of the LIMA injury at proximal, mid, and distal locations. By applying axillary bypass, LIMA extension, and repair over a shunt approaches, our protocol can be used as a successful bailout to LIMA damage in minimally invasive coronary cases.