To assess the indications and clinical outcome of minimally invasive coronary artery bypass grafting with mini-sternotomy and cardiopulmonary bypass (MICS-CABG) for patients with multiple coronary artery disease, left main trunk stenosis and/or concomitant heart diseases, we examined results in 17 patients (mean age 62.5 years) who underwent MICS-CABG. The average number of distal anastomoses was 2.2 anastomoses/patient. The category of the coronary lesions was the left main trunk in 6 patients, triple vessel disease in 7, double vessel disease in 3, and left anterior descending artery stenosis with aortic regurgitation in 1 patient. Each operative procedure through the mini-sternotomy was easily and completely performed in all patients. By means of postoperative coronary angiography, full patency without stenosis in all grafts was recognized in 95.0%. Immediately after the MICS-CABG, all patients showed quick recovery of respiration, and postoperative admission duration significantly decreased compared with standard CABG with full sternotomy. The above results suggest that MICS-CABG is one of the procedures of choice for patients with multiple coronary artery disease, left main trunk stenosis and/or concomitant heart diseases.

In repair of the tricuspid valve (TV) due to Ebstein's anomaly, mobilization of the anterior leaflet associated with longitudinal right ventricle placation (Carpentier's procedure) has provided good results in both short- and long-term follow-up. However, if the anterior leaflet is small or severely deformed, such repair may be ineffective. We report two cases of Ebstein's anomaly (63 and 53 years old) with deformed anterior leaflets of the TV in whom Carpentier's procedure was not feasible. In one patient, the anterior leaflets were broadly plastered on the right ventricle and Carpentier's procedure was tried. However, the repair was converted to valve replacement because of significant residual regurgitation. The other patient had a cleft in the anterior leaflet, therefore Carpentier's procedure was not suitable. The repair restructured the valve mechanism below the true annulus by using the most mobile leaflets for valve closure (modified Hetzer's procedure). This method of repair could be an alternative method to repair of the TV in Ebstein's anomaly, particularly when the anterior leaflet is deformed.