LESS-INVASIVE CORONARY-ARTERY BYPASS-GRAFTING - DIFFERENT TECHNIQUES AND APPROACHES

Objective: The aim of this study was to compare four different techniq ues for less-invasive coronary artery bypass surgery with and without cardiopulmonary bypass (CPB) in terms of feasibility as well as in ter ms of the intra- and postoperative course. Methods: One hundred and fo urteen patients were divided into four groups, according to the surgic al technique. Group I: minithoracotomy, internal thoracic artery (ITA) harvesting and anastomosis under direct vision using cardiopulmonary bypass (CPB) on the fibrillating heart (n = 31). Group II: sternotomy and beating heart without CPB (n = 13). Group III: MIDCAB with CPB and cardioplegic cardiac arrest using endo-aortic balloon-occlusion, Port Access system (n = 9). Group IV: MIDCAB on the beating heart without CPB (n = 61). In total, 104 single and ten double graft procedures wer e performed using the radial artery T-graft technique in seven cases ( groups III and IV). Results: Harvesting of the ITA graft took 41 +/- 1 6.2 min in group I and could be reduced to 31 +/- 8.3 min in group IV by the use of a specially-designed retractor. Complications were: deat h (n = 1, group I), myocardial infarction, (n = 1, group I), early occ lusion of the graft (n = I, group IV), early stenosis of the anastomos is (n = 2, groups I and IV), late stenosis of the anastomosis (n = 1, group IV), thrombosis of the femoral vein (n = 1, group III). Postoper ative ventilation, ICU and hospital stay were similar among groups. Co nclusions: Based on our results, the following strategy has been devel oped: MIDCAB without CPB is the preferred technique for one-vessel gra ft procedures to the left anterior descendens (LAD) or RCA. The Port A ccess system (with CPB) is reserved as a second option for young patie nts requiring multiple-vessel grafting to the left coronary circulatio n (LAD/CX) and as a backup to avoid conversion. Sternotomy and an off- pump technique is used for single-vessel or multiple-vessel graft proc edures in selected patients (emergency procedure, acute myocardial inf arction, in the very obese). (C) 1998 Elsevier Science B.V. All rights reserved.