Minimally invasive direct coronary artery bypass for redo patients

Background. The minimally invasive direct coronary artery bypass (MIDCAB) p rocedure, using a small anterolateral thoracotomy without cardiopulmonary b ypass, has been recommended for high-risk patients because it is less traum atic than conventional coronary artery bypass grafting. For redo patients w ho have patent grafts and pericardial adhesions, the MIDCAB may be preferab le to the conventional operation because manipulation of the graft and diss ection of adhesions may be minimized. Methods. Since November 1995, 120 patients underwent the MIDCAB procedure i n our institution. Among these patients, there were 25 redo cases (20.8%). We reviewed these redo cases and studied their surgical results (mortality, morbidity, hospital stay, operation time, and postoperative inotropic supp ort). To clarify the usefulness of this procedure, we compared the results of redo operations with those of the first-time operations. Results. For redo MIDCAB, there was one operative death (4%) because of int estinal infarction. The mean hospital stay was 4.3 days and the number of p atients who needed postoperative positive inotropic agents was 3 (12%). The re was no significant differences between redo and first-time operation pat ients in mortality, morbidity, hospital stay, operation time, and postopera tive inotropic support. Conclusions. Results of the MIDCAB procedure for redo patients were compara ble to those for primary MIDCAB operations. (C) 1999 by The Society of Thor acic Surgeons.