Multiple minimally invasive direct coronary artery bypass grafting for thecomplete revascularization of the left ventricle

Background. Single-vessel coronary artery bypass grafting of the left inter nal mammary artery to the left anterior descending coronary artery using a minithoracotomy has been shown to produce excellent results with a very low mortality rate. However, this procedure cannot be used in patients with do uble- or triple-vessel disease. Our goal was to develop a minimally invasiv e direct coronary artery bypass grafting without cardiopulmonary bypass for total revascularization of the left ventricle using multiple arterial graf ts. Methods. Limited lateral thoracotomy was performed in the fourth or fifth i ntercostal spaces, exposing the left anterior descending coronary artery an d left circumflex coronary artery. Two or three arterial grafts were harves ted. Revascularization of the left anterior descending coronary artery and the left circumflex coronary artery were performed in 20 patients without c ardiopulmonary bypass through the limited lateral thoracotomy using complex performed arterial grafts. In 4 patients, triple- and quadruple-vessel gra fting was performed. Results. The mean coronary cross-clamp time was 14.5 +/- 4.0 minutes for th e left anterior descending coronary artery and 16.8 +/- 5.1 minutes for the left circumflex coronary artery. No early deaths or postoperative complica tions occurred. There were no late deaths or angina during the mean follow- up of 7.0 months (range, 2 to 22 months). Postoperative coronary angiograph y demonstrated widely patent grafts in all patients. Conclusions. Minimally invasive approach through a limited thoracotomy in m ultiple coronary artery bypass graftings are technically feasible and may b e an alternative approach in the complete revascularization of the left ven tricle, Mechanical immobilization of the coronary artery enhances early gra ft patency and is an essential part of this procedure. (C) 1999 by The Soci ety of Thoracic Surgeons.