Mini OPCAB in severe COPD-world's first report of three cases.

Chronic obstructive pulmonary disease (COPD) among patients requiring coronary artery bypass graft is common and is associated with worse outcomes. Although off pump coronary artery bypass (OPCAB) ameliorates cardiopulmonary bypass related derangements, COPD is still an independent risk factor for adverse outcomes. As minimally invasive direct coronary artery bypass is an absolute contraindication in COPD, an alternative minimally invasive approach is imperative to optimize outcomes. We present the world's first reported cases in the literature of Mini OPCAB performed successfully in three patients with severe COPD that received left internal mammary artery to left anterior descending artery (LAD) revascularization. All three patients were discharged on the first post-operative day with nil complications. All three patients were well at 3 months follow-up, having returned to their normal daily routine by 3 weeks with normal wound healing and without hospital readmission. Therefore, Mini OPCAB as a minimally invasive approach seems an attractive and feasible option in severe COPD, particularly those requiring revascularization to single vessel (LAD). This is the first documented report of Mini OPCAB performed successfully in patients with severe COPD.