MINIMAL ACCESS SURGICAL TECHNIQUES IN CORONARY-ARTERY BYPASS-GRAFTINGFOR TRIPLE-VESSEL DISEASE

Background. Minimal access surgical techniques in coronary artery bypa ss grafting have been used mainly in the management of single-vessel d isease. Methods. Fifteen patients, 11 men and 4 women with a mean age of 64.1 years (range, 35.7 to 78.0 years), underwent operation for tri ple-vessel disease using minimal access techniques. The procedures wer e performed through a limited left parasternal thoracotomy using femor ofemoral extracorporeal circulation. The myocardium was protected by t he antegrade infusion of cold blood cardioplegic solution while the ao rta was cross-clamped. Results. Under direct vision, the left saphenou s vein grafts were connected sequentially to the diagonal branch, obtu se marginal branch, and posterior descending branch, and the left inte rnal thoracic artery graft was anastomosed to the left anterior descen ding artery in each patient. The mean aortic cross-clamp time was 86 /- 17 minutes (range, 67 to 125 minutes). The mean duration of extraco rporeal circulation was 112 +/- 22 minutes (range, 82 to 162 minutes). The postoperative course was uneventful in all patients. Follow-up wa s complete in all patients at a mean of 7.4 months (range, 6.0 to 8.5 months), and there were no late deaths or angina. Coronary angiography in 8 patients showed patent grafts. Conclusions. Our experience demon strates that minimal access surgical techniques in coronary artery byp ass grafting are technically feasible and may be an alternative approa ch in the surgical revascularization of triple-vessel disease.