Intra- and postoperative quality control in minimally invasive direct coronary artery bypass (MIDCAB) surgery

direct coronary artery revascularisation without sternotomy and extracorpor eal circulation - called Minimally (or less) Invasive Direct Coronary Arter y Bypass grafting (MIDCAB) has opened up interesting perspectives for the t reatment of patients with limited coronary artery disease. However, like an y newer surgical technique, this approach to myocardial revascularisation r equires a critical appreciation of the results which may be obtained; when introducing the MIDCAB technique in our institution we developed a quality control protocol based on intraoperative as well as early and late postoper ative parameters. This protocol is designed to detect every significant adv erse event, exercise capacity and quality of life of our patients. Moreover , several invasive parameters have to be recorded in the protocol, such as intraoperative flow in the internal mammary artery conduit, the angiographi c verification of anastomotic patency at one-year follow-up and determinati on of coronary flow reserve. The results of the first 5 patients observed up to one year postoperatively are presented: all anastomoses were patent and the flow within the interna l mammary artery was 69 +/- 40 ml/min at one-year follow-up angiography; th is compares very favourably with the flow measured at the end of the operat ion, which was 31 +/- 8 ml/min. This demonstrates very clearly that interna l mammary artery flow is recruitable and usually significantly increases wi thin the first months postoperatively. Coronary flow reserve was 3.4 +/- 1. 1 (normal value >2.5). The results obtained in this pilot study, which was designed to establish a quality control protocol, are very satisfactory and confirm previous exper ience that this technique may be offered to selected patients with appropri ate coronary anatomy.