THE H-GRAFT - AN ALTERNATIVE APPROACH FOR PERFORMING MINIMALLY INVASIVE DIRECT CORONARY-ARTERY BYPASS

Objectives: Minimally invasive direct coronary artery bypass permits a rterial revascularization without cardiopulmonary bypass, potentially decreasing associated morbidity. The procedure is, however, technicall y challenging and associated with significant postoperative pain resul ting from retraction through the small incision, Methods and patient s election: From December 1996 to April 1997, eight patients underwent g rafting of the left anterior descending coronary artery by use of a sh ort segment of right inferior epigastric artery attached proximally to the side of an in situ left internal thoracic artery, We have termed this procedure the ''H'' graft MIDCAB, Results: No patients required i ntraoperative conversion to conventional bypass, No postoperative deat hs or myocardial infarctions occurred, Six patients with normal renal function underwent postoperative angiography that demonstrated graft p atency with rapid filling of the left anterior descending coronary in each case, Postoperatively clinical signs of acute ischemia were resol ved or a normal exercise tolerance test was obtained in all patients, The median postoperative length of stay was 3 days, Rib spreading and chest wall retraction were not required in any procedure, Conclusions: The ''H'' graft procedure is an attractive alternative to standard mi nimally invasive bypass because of greater technical simplicity, the a voidance of internal thoracic artery harvest, and excellent visualizat ion with no chest wall retraction.