MAMMARY CORONARY-ARTERY ANASTOMOSIS WITHOUT CARDIOPULMONARY BYPASS THROUGH MINITHORACOTOMY - ONE-YEAR CLINICAL-EXPERIENCE

Objective: The recent concept of minimally invasive coronary artery su rgery in selected patients has dramatically affected surgical manageme nt of coronary artery disease. We explored the possibility of coronary artery bypass grafting of anterior coronary arteries with in situ int ernal mammary artery through a limited anterior thoracotomy on beating heart. Method: Minithoracotomy and direct coronary artery surgery wit hout cardiopulmonary bypass (CPB) was attempted in 116 patients. The p rocedure was completed in 108 cases while in eight cases minithoracoto my was converted to mid sternotomy. In 107 cases, left internal mammar y artery (LIMA) to left anterior descending (LAD) coronary artery anas tomosis was done through left anterior minithoracotomy and in one case LIMA to LAD and right internal mammary artery (RIMA) to right coronar y artery (RCA) anastomosis was done through bilateral minithoracotomy. Left anterior minithoracotomy through 4th intercostal space and right anterior minithoracotomy through 5th intercostal space was used for l eft and right internal mammary artery dissection respectively. With th is approach 4-8 cm length of mammary artery was easily dissected. Mamm ary coronary artery anastomosis were performed on a beating heart with out CPB through window pericardiotomy. Two patients also underwent lef t carotid endarterectomy along with LIMA to LAD anastomosis. In two pa tients complementary percutaneous transluminal coronary angioplasty (P TCA) to circumflex artery was done 5 days after minithoracotomy and LI MA to LAD anastomosis. Results: Forty-two patients were extubated in t he operating room and 66 in the intensive care unit 2-10 h after surge ry. Blood transfusion was used in one case who was reexplored for post operative bleeding due to a displaced hemoclip from the internal mamma ry artery branch. None of these patients required inotropic support. P ostoperative predischarge check angiogram in 53 cases revealed adequat e mammary coronary flow in 51 cases, the remaining two had anastomotic problems, one was subjected to PTCA and the other for redo coronary b ypass grafting through mid sternotomy. Doppler flow assessment of anas tomosis was done in 102 cases, of which two showed problems which was confirmed on check angiography. One-hundred and six patients are in ou r regular follow-up (mean follow-up 10 +/- 1.5 months), 98 of them are in functional class I. Conclusion: In our experience mammary coronary artery anastomosis without CPB through minithoracotomy is a safe, sim ple and minimally invasive procedure. Favorable cost/benefit ratio, ha s been achieved due to no early/late mortality and minimal early morbi dity. Postoperative check angiogram and Doppler flow study revealed ex cellent mid term results. (C) 1998 Elsevier Science B.V. All rights re served.