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.