Results of graft patency by immediate angiography in minimally invasive coronary artery surgery

Background. Although minimally invasive direct coronary artery bypass (MIDC AB) is being employed for revascularization of the left anterior descending coronary artery (LAD) with the left internal mammary artery (LIMA), little objective data exist regarding graft patency. Because the procedure is per formed on a beating heart through a limited access approach, concerns have been raised regarding the ability to perform as accurate an anastomosis com pared with conventional coronary artery bypass (CAB). Methods. A prospective study of consecutive patients undergoing MIDCAB LIMA to LAD was undertaken. All procedures were performed through a limited ant erior thoracotomy incision with a stabilization device. Selective angiograp hy of the LIMA graft was performed intraoperatively or in the immediate pos toperative period. Results. One hundred and three patients underwent the MICAB procedure. Angi ographic evaluation of the anastomosis was obtained in 100 patients (97%). Angiographic graft patency was 99%, with perfect graft patency (no stenosis greater than 50%) being 91%. Three grafts were revised in the operating ro om. One patient underwent reoperation and 3 more underwent percutaneous tra nsluminal coronary angioplasty. There were two noncardiac mortalities (1.9% ), both with patent grafts. Conclusions. Immediate graft patency after MIDCAB is acceptable, and compar able with conventional CAB data, although meaningful comparison is difficul t. The significance of early angiographic findings and the role for early a ngiography remain to be defined. (C) 1999 by The Society of Thoracic Surgeo ns.