Minimally invasive coronary artery surgery

Background: There is a growing interest to perform a left internal mammary artery (LIMA) graft to the left anterior descending coronary artery (LAD) o n a beating heart through a minimally invasive access to the chest cavity. Aim: To report the experience with minimally invasive coronary artery surge ry. Patients and methods: Analysis of 11 patients aged 48 to 79 years old w ith single vessel disease that, between 1996 and 1997, had a LIMA graft to the LAD performed through a minimally invasive left anterior mediastinotomy , without cardiopulmonary bypass. A 6 to 10 cm left parasternal incision wa s done. The LIMA to the LAD anastomosis was done aster pharmacological hear t rate and blood pressure control and a period of ischemic preconditioning. Graft patency was confirmed intraoperatively by standard Doppler technique s. Patients were followed for a mean of 11.6 months /7-15 months). Results: All patients were extubated in the operating room and transferred out of t he intensive care unit on the next morning. Seven patients were discharged on the third postoperative day. Duplex scanning confirmed graft patency in all patients before discharge; in two patients, it was confirmed additional ly by arteriography. There was no hospital mortality, no perioperative myoc ardial infarction and no bleeding problems. After follow up ten patients we re free of angina, in functional class I and pleased with th surgical and c osmetic results. One patient developed atypical angina on the seventh posto perative month and a selective arteriography confirmed stenosis of the anas tomosis. A successful angioplasty of the original LAD lesion was carried ou t. Conclusions. A minimally invasive left anterior mediastinotomy is a good surgical access to perform a successful LIMA to LAD graft without cardiopu lmonary bypass, allowing a shorter hospital stay and earlier postoperative recovery. However, a larger experience and a longer follow up is required t o define its role in the treatment of coronary artery disease.