LESIONS OF THE TARGET VESSEL DURING MINIMALLY INVASIVE MYOCARDIAL REVASCULARIZATION

Background. Minimally invasive coronary artery bypass grafting has rec ently been introduced into cardiac surgery. In this report we discuss the incidence of surgically induced distal target vessel stenosis in p atients who undergo the minimally invasive coronary artery bypass graf ting procedure, which represents a major drawback of the procedure in our experience. Methods. Doppler evaluation of mammary artery flow was performed postoperatively in all 55 patients who underwent minimally invasive coronary artery bypass grafting at our institution. Angiograp hy was performed in the first 35 consecutive patients for control purp oses and in 2 patients who complained of angina recurrence. Results. I n 32 of the first 35 consecutive patients, the anastomosis was found t o be functioning normally and the distal left anterior descending arte ry was normal; in the remaining 3 patients we found mammary artery occ lusion, anastomotic stenosis, and stenosis of the anastomosis and the distal left anterior descending artery in 1 patient each. A distal lef t anterior descending artery stenosis was found in the only 2 patients who underwent late angiography. Conclusions. Surgically induced dista l target vessel stenosis represents a major drawback of minimally inva sive coronary artery bypass grafting in our experience. Further improv ement in the means of achieving coronary artery occlusion, as well as in anticoagulant and antiplatelet therapy, is mandatory before minimal ly invasive coronary artery bypass grafting can be confidently accepte d into clinical practice. (C) 1997 by The Society of Thoracic Surgeons .