MINIMALLY INVASIVE CORONARY-ARTERY BYPASS-GRAFTING WITHOUT CARDIOPULMONARY BYPASS - EARLY EXPERIENCE AND FOLLOW-UP

Background. There is renewed interest in coronary artery bypass grafti ng without cardiopulmonary bypass using the anterolateral minithoracot omy approach. We evaluated 209 patients who underwent minimally invasi ve direct coronary artery bypass grafting using an anterolateral minit horacotomy. The anastomosis was performed under direct vision on the b eating heart without using cardiopulmonary bypass. Methods. The proced ure was performed using a 6- to 9-cm left (or right) anterolateral tho racotomy for internal thoracic artery graft harvesting and anastomosis . Different devices were used for local immobilization. In 195 patient s a single internal thoracic artery to left anterior descending corona ry artery bypass was performed, in 3 patients a single right internal thoracic artery to right coronary artery bypass, and in 11 patients th e radial artery was used together with the internal thoracic artery as a T-graft. Results. Conversion to sternotomy or cardiopulmonary bypas s was necessary in 10 (4.7%) patients. Intraoperative myocardial infar ction was observed in 4 patients (1.9%). Early postoperative redo oper ation was necessary in 5 patients (2.4%). Mortality was 0.47%. Postope ratively, 191 patients (91.3%) underwent angiography for graft patency control. The overall patency rate was 97.3%. Minor stenosis of the in ternal thoracic artery graft was observed in 18 patients (9.4%); moder ate stenosis was observed in 5 patients (2.6%). Midterm angiographic f ollow-up after 6 months was performed in 58 patients. The patency rate was 98.2%. One patient with severe symptomatic stenosis (1.7%) underw ent reoperation. Conclusions. With the help of the local immobilizatio n systems off-pump coronary artery bypass grafting was safely performe d through a minithoracotomy. The incidence of intraoperative and posto perative complications was low and follow-up showed good results. Thus , minimally invasive direct coronary artery bypass grafting is an exce llent technique for arterial revascularization in patients having symp tomatic left anterior descending coronary artery disease.