MINIMALLY INVASIVE CORONARY-ARTERY BYPASS-GRAFTING WITHOUT CARDIOPULMONARY BYPASS

To determine the feasibility and the effectiveness of minimally invasi ve direct coronary artery bypass without cardiopulmonary bypass (MICAB G) in patients with left anterior descending (LAD) coronary artery dis ease, we evaluated 90 consecutive patients who underwent MICABG at the University Hospital of Groningen. Patients: Between January 1995 and December 1996, 50 patients (mean age 60 +/- 10.3 years) with documente d myocardial ischemia and isolated stenosis of the LAD were selected f or MICABG. Patients with any associated cardiac disease or with acute or evolving myocardial infarction were excluded. Methods: A small left antero-lateral thoracotomy in the 5th intercostal space was made in a ll patients, anastomosing the left internal mammary artery (LIMA) to t he LAD. A short-term (3 days) postoperative rehabilitation programme w as used. Emotional stress (STAY-DY-1 score), wound pain (VAS: visual a nalogue score) and O-2-saturation after a 6 min walking test were meas ured during hospitalisation and at the first follow-up examination (2. 5 week after discharge). Results: Mean operative time was 92 +/- 25 mi n (range 60-170). We recorded 1 (1.1%) in-hospital death and three cas es (3.3%) of perioperative myocardial infarction. In two cases the MIC ABG was converted to the midline sternotomy. One patient underwent urg ent reoperation on postoperative day 1 via midline sternotomy. Mean ho spital stay was 4.4 +/- 2 days. Emotional stress was significantly red uced during and after hospitalisation, compared with the admission day . Wound pain was mild (3.5/10 VAS) on postoperative day 1 and reduced significantly during hospitalisation and at first follow-up examinatio n. O-2-saturation after a 6 min walking test had significantly improve d at the first follow-up examination. Conclusion: These results indica te that MICABG is feasible and effective in patients with LAD stenosis and leads to a fast psyche-physical recovery. (C) 1997 Elsevier Scien ce B.V.