MINIMALLY INVASIVE CORONARY SURGERY WITH THORACOSCOPIC INTERNAL MAMMARY ARTERY DISSECTION - SURGICAL TECHNIQUE

Background: We describe our technique of revascularization of the left anterior descending artery (LAD), using the left internal mammary art ery (LIMA) without cardio- pulmonary bypass (CPB), by means of a 4-cm left thoracotomy and video-thoracoscopic harvesting of the LIMA. Metho ds: The patient is placed in a semioblique position. The LIMA is harve sted under thoracoscopic guidance. Trocars are introduced via three th oracic incisions of Less than 15 mm at the Level of the fourth and sev enth intercostal spaces. Perforating arterial branches are cauterized or clipped. This approach allows complete dissection of the LIMA from the subclavian artery to the fifth intercostal space. A 4-cm Left ante rior thoracotomy is then made along the fourth or the fifth intercosta l space. Rib excision is not necessary for LAD exposure. Coronary arte ry control is obtained with looping sutures (4/0 prolene) placed proxi mally and distally to the site of the anastomosis. Anastomosis is then performed with 8/0 prolene on the beating heart, under direct vision, without CPB. Results: Between September 1995 and May 1996, this proce dure was performed on 20 consecutive patients under age 80. There were no operative complications. The mean duration of hospitalization was six days. Conclusions: This new procedure enlarges the field of minima lly invasive coronary artery bypass grafting techniques.