Minimally invasive revascularization of the anterior myocardial vessels ona beating heart

The value of minimally invasive techniques in relation to conventional coro nary surgery is not clearly established and frequently very; controversiall y discussed. Among the different minimally invasive procedures, the MIDCAB (minimally in vasive direct coronary artery bypass) represents the most commonly applied technique. Accordingly, revascularization of anterior myocardial vessels is performed via a mini-thoracothomy on the beating heart with a left IMA gra ft. Since 6/96, 306 patients in part with a significant degree of comorbidi ty or more complex cardiac findings received MIDCAB grafting. Primarily all patients survived the procedure with stabile hemodynamics. Ho wever, subsequently 4 patients later died due to cardiac (n = 2) or noncard iac reasons (n = 2). Beyond that, no other patient developed a myocardial i nfarction. Conversion to conventional techniques became necessary in 3 case s. Control angiographies revealed global patency rates of 98.3 %. In additi on, 4 malinsertion of the LIMA to diagonal branches were observed. MIDCAB grafting of anterior myocardial vessels appeared effective and safe. Especially for patients facing a high risk in conventional coronary surger y or with nonsatisfying interventional results, this approach might be supe rior.