Early experience with minimally invasive direct coronary artery bypass grafting with the internal thoracic artery

Objective: Minimally invasive direct coronary artery bypass is performed un der direct vision without sternotomy or cardiopulmonary bypass. The techniq ue can be used in both primary and reoperative cases by employing the inter nal thoracic artery to perform arterial revascularization of the anterior s urface of the heart. Methods: Patients were selected who had significant co ronary artery disease limited to 1 or 2 coronary distributions on the anter ior surface of the heart. Coronary target vessels were grafted with the int ernal thoracic artery through a small anterior thoracotomy. After partial h eparinization the anastomosis was facilitated by local coronary occlusion a nd handheld stabilization. Results: Between August 1994 and July 1997, 162 patients underwent minimally invasive direct coronary artery bypass graftin g with the internal thoracic artery. The left and right internal thoracic a rteries were used for grafting of the left anterior descending artery in 14 2 patients (88%), the proximal right coronary artery in 7 patients (4%), ex isting saphenous vein grafts in 5 patients (3%), and diagonal branches in 2 patients (1%), Sequential grafting with the left internal thoracic artery was performed in 2 patients (1%) and bilateral internal thoracic artery gra fting was performed in 4 patients (3%), Eight patients (4.9%) died within 3 0 days after the operation, 3 of cardiac causes. Seven additional patients died during the follow-up period, Nine patients (5.6%) required reintervent ion for graft stenosis or occlusion during follow-up. Of 141 patients seen 2 or more weeks after the operation, 135 (96%) had resolution of their angi nal symptoms at a mean follow-up of 12 months (range 0-31 months). Conclusi ons: Anterior minimally invasive direct coronary artery bypass grafting wit h the internal thoracic artery avoids the risks of repeated sternotomy, aor tic manipulation, and cardiopulmonary bypass. There was a low rate of reint ervention, and patients had excellent resolution of anginal symptoms, Posto perative length of stay was comparatively short, and continued follow-up wi ll be essential to evaluate long-term graft patency and patient survival.