Initial experience with MIDCAB grafting using the gastroepiploic artery

Background. Minimally invasive direct coronary artery bypass grafting with the gastroepiploic artery can be used in primary operations and reoperation s to revascularize the inferior or anterior surface of the heart. Methods. Patients who had symptomatic coronary artery disease limited to a single coronary distribution were selected. Coronary targets were grafted w ith the pedicled gastroepiploic artery through a small midline epigastric i ncision. Patients were followed with scheduled outpatient clinic visits, Do ppler examination, and selective recatheterization. Results. Between May 1995 and November 1997, 74 patients underwent gastroep iploic artery minimally invasive direct coronary artery bypass grafting; 33 (45%) had a primary operation and 41 (55%), a reoperation. Grafting was pe rformed to the distal right coronary artery (n = 38), the posterior descend ing artery (n = 28), or the distal left anterior descendng coronary artery (n = 8). There were six deaths (8%) within 30 days after operation. Twenty patients (28%) underwent recatheterization; there were two graft occlusions , two graft stenoses, and five anastomotic stenoses. Of 60 patients seen 2 or more weeks after operation, 53 (88%) had resolution of anginal symptoms at a mean follow-up of 10.9 months (range, 0 to 30 months). Conclusions. Inferior minimally invasive direct coronary artery bypass graf ting with the gastroepiploic artery avoids the risks of repeat sternotomy, aortic manipulation, and cardiopulmonary bypass. Patency rates, however, we re lower than expected, and there is significant morbidity and mortality as sociated with high-risk patients undergoing the procedure. Continued follow -up is essential to evaluate long-term graft patency and patient survival. (C) 1999 by The Society of Thoracic Surgeons.