VIDEO-ASSISTED MINIMALLY INVASIVE CORONARY-BYPASS SURGERY WITHOUT CARDIOPULMONARY BYPASS

Background: There is a growing interest in cardiac surgery towards min imally invasive approach to coronary bypass operations without cardiop ulmonary bypass. Patients and methods: From March 1995 to March 1997, 41 patients underwent a single left internal mammary artery (LIMA) to the left anterior descending artery (LAD) coronary grafting without ca rdiopulmonary bypass through a small left anterior thoracotomy (MIDCAB G). The mean age was 61.2 +/- 8.7 years (range 43-77 years), 28 patien ts. were male (68.2%) and the redo rate was 4.8%, (2/41). In all patie nts the coronary artery disease involved the LAD, which was occluded i n seven patients (17.1%). Thirty-eight patients (96.2%) selected for M IDCABG had a monovascular disease on LAD not suitable for percutaneous coronary angioplasty; two: (4.8%) a bivascular disease, and one (2.4% ) a trivascular disease. Skin incision was performed in the 4th anteri or intercostal space from the left parasternal tine For a 10.5 cm leng th on average. The LIMA harvesting was partially video-assisted by tho racoscopy. Results: The LAD temporary occlusion was achieved with two double 5/0 polypropilene round-LAD sutures. The mean LAD ischemic time was 22 +/- 8 min (range 4-35 min). No thoracotomy procedure was chang ed into a sternotomy approach. We had one (2.4%) perioperative AMI; tw o patients (4.8%) were reoperated for bleeding. All patients underwent a postoperative angiographic reinvestigation within 1 month after sur gery. All anastomoses were perfectly patent but two (4.8%). One patien t was reoperated via a sternotomy access recycling the LIMA graft, the other one underwent successful PTCA. AII patients also underwent an e arly and mid-term (6 months after surgery) echo-Doppler study of the L IMA flow and patency. At follow-up, performed at a mean of 8.7 months (range 1-23) after discharge, all patients were alive; no one experien ced recurrence of angina. All patients also performed a mid-term negat ive treadmill stress test. Conclusions: MIDCABG ii;, in selected patie nts, reliable and safe, and offers encouraging early and mid-term clin ical results. (C) 1998 Elsevier Science B.V. All rights reserved.