MINIMALLY INVASIVE LAD REVASCULARIZATION IN HIGH-RISK PATIENTS WITH 3-VESSEL CORONARY-ARTERY DISEASE

Objective: A potential advantage of minimally invasive direct coronary artery bypass (MIDCAB) is that patients in whom conventional coronary bypass surgery is associated with increased risk because of various a ssociated medical conditions, or those with relative contraindications to cardiopulmonary bypass, can benefit from surgical revascularisatio n. We reviewed our experience with adopting MIDCAB in the management o f patients with three-vessel coronary artery disease over an 8 month p eriod. Methods: Thirteen patients (3 females, mean age 67.6 years) wit h severe symptomatic three vessel coronary artery disease on maximum m edical treatment (angina class III or IV) received left internal mamma ry artery grafts to the left anterior descending coronary artery using the MIDCAB approach. Associated co-morbidity included: severe chronic renal failure (n=2), severe extensive arteriopathy (n=4), chronic obs tructive airway disease (n=2), poor general condition (n=2) and severe ly impaired left ventricular function (n=3). Results: There was one ea rly postoperative mortality and no other cardiac related morbidity. Al l patients were extubated within 3 h of leaving the operating room, me an ITU stay was 15 h and mean hospital stay was 5 days. Graft patency was investigated using angiography in all patients; all grafts but two were patent. In combination with medical therapy, all patients remain entirely angina free at a follow-up period between 3-11 months. Concl usions: MIDCAB is an effective approach for managing high-risk patient s with symptomatic three-vessel coronary artery disease. Longer follow -up is needed to further clarify patient selection and the long-term o utcome of this approach. (C) 1997 Elsevier Science Ireland Ltd.