Port-Access (TM) coronary artery bypass grafting: Technical considerationsand results

Background: This study reviews the results of an initial experience with mi nimally invasive coronary bypass surgery using the Port-Access(TM) approach in terms of early outcome and safety. Methods: Between October 1996 and Ju ly 1997 49 Port-Access(TM) minimally invasive coronary artery bypass grafti ng procedures were performed at our institution. The patients' mean age was 59.8 years (range 34 to 82 years). Sixteen patients received single vessel and 37 patients received multivessel bypass grafts. Results: There were no operative deaths and no perioperative myocardial infarctions, neurological deficits, or conversions to sternotomy. Early complications included reope ration due to bleeding in 4 patients, reoperation for a pulmonary embolus i n 1 patient, and angioplasty for occlusion of a right coronary artery graft in 2 patients. postoperative angiograms were obtained in 86% (42/49) of th e patients and showed 100% patency for left internal mammary artery to left anterior descending artery grafts and 96% patency for all grafts. Conclusi ons: These results demonstrate that Port-Access(TM) coronary artery bypass grafting using endovascular techniques for cardiopulmonary bypass and cardi oplegic arrest can be performed safely with minimal morbidity and mortality . This technique allows multivessel revascularization on a protected, arres ted heart with excellent anastomotic precision and reproducible early graft patency. Expanded use of Port-Access(TM) techniques is indicated in patien ts with multivessel coronary artery disease and the technique should be con sidered for patients with left anterior descending artery restenosis and pa tients with complex left anterior descending artery lesions where angioplas ty results are suboptimal.