ANATOMICAL STUDIES CONCERNING TECHNICAL FEASIBILITY OF MINIMALLY INVASIVE AXILLOCORONARY BYPASS-GRAFTING

Objective: Minimally invasive multiple vessel revascularization has be en accomplished using all arterial graft concepts and aortocoronary ve in grafts. The aim of the present study was to determine the technical feasibility of minimally invasive axillary artery to coronary artery vein grafting in the human cadaver. Methods: In seven human cadavers t he axillary artery was approached bilaterally via a small incision abo ve the anterior axillary fold. The left anterior descending coronary a rtery system and the right coronary artery system were exposed via a l eft anterior minithoracotomy and a subxiphoid incision respectively. S aphenous vein grafts were anastomosed end to side to the axillary arte ry and brought to the target vessels following a transpleural route. T he vein grafts were then sutured to the left anterior descending arter y and to the posterior descending artery through the mini-incisions. R esults: Axillocoronary bypass grafting to the left anterior descending artery was performed successfully in seven cases, axillocoronary bypa ss grafting to the posterior descending artery was accomplished in six cases. The mean length of the mini-incisions was as follows:left axil lary artery exposure 5.1 +/- 1.5 cm, right axillary artery exposure 5. 5 +/- 2.0 cm, left anterior minithoracotomy 10.8 +/- 1.9 cm, subxiphoi d incision 9.4 +/- 1.9 cm. The mean length of saphenous vein required for the left axillary artery to left anterior descending artery bypass was 18.9 +/- 2.8 cm, the mean length of vein required for the right a xillary artery to posterior descending artery bypass was 26.0 +/- 2.6 cm. This was significantly longer than the aortocoronary route (ascend ing aorta to left anterior descending artery 12.5 +/- 2.2 cm P = 0.000 1, ascending aorta to posterior descending artery 18.3 +/- 2.9 cm P < 0.0001). Conclusion: From this study we conclude that minimally invasi ve axillocoronary venous bypass grafting to the left anterior descendi ng artery system and to the distal right coronary artery system is tec hnically feasible in the human cadaver. (C) 1998 Elsevier Science B.V.