Minimal invasive surgery for coronary heart disease: a new alternative

To avoid the inflammatory syndrome generated by cardiopulmonary bypass, a n ew surgical technique, minimal invasive direct coronary artery bypass (MIDC AB), has been developed. An anastomosis is performed between the left inter nal mammary artery (LIMA) and the left anterior descending artery (LAD) on a beating heart, through a limited anterior thoracotomy. We describe our ex perience with this technique. Ten consecutive patients underwent a MIDCAB procedure. (9 males, age 65.9+/ -9 years). There were 8 bypasses of the LIMA on the LAD, one bilateral mamm ary bypass on the LAD and the right coronary artery, and one conversion to a standard sternotomy with CPB for a saphenous vein bypass on the LAD becau se of injury to the LIMA (2nd case). There was one redo for haemostasis of the mammary artery bed (3rd case). The first 3 patients required postoperat ive blood transfusion. From the 4th operation onwards, with the introductio n of new instrumentation which was better adapted to the narrowness of the surgical field, there were no further surgical complications. During the fo llow-up (mean 5 months; range 2-9), no patient suffered anginal recurrence. With the improvement of instrumentation, the MIDCAB technique offers satisf actory short- and mid-term results, while avoiding CPB with its adverse eff ects. Lastly, the cosmetic result is far better than with the conventional procedure.