Minimally invasive coronary artery revascularization on the beating heart

Background. The quality of surgical beating heart revascularization is freq uently questioned, especially when the surgical access is limited. Neverthe less, the number of off-pump coronary procedures is expanding worldwide. Methods. Since getting started with minimally invasive direct coronary arte ry bypass to anterior myocardial vessels in June 1996, 306 patients receive d left internal mammary artery grafting through an anterior minithoracotomy . Risk increasing comorbidities were present in 168 of them. Particular att ention was paid to early postoperative angiographic results and complicatio ns. Results. The 30-day mortality summed up at 1.0% and was limited to patients with additional risks for conventional bypass grafting. Early postoperativ e control angiographies in 232 patients confirmed a global patency rate of 97.8%, revealing in addition four unexpected malinsertions to diagonal bran ches. In surviving patients major complications like myocardial infarction, stroke, or multiorgan failure were completely absent. Conclusions. Minimally invasive direct coronary artery bypass grafting appe ars to allow for a safe and effective revascularization of the left anterio r descending artery by use of the left internal mammary artery. Especially patients with risk increasing comorbidities should benefit from this approa ch, provided the surgical indication based on a dominating left anterior de scending artery lesion. Angiographic minimally invasive direct coronary art ery bypass results seem to fulfill the expectations generated by results ob tained in conventional left internal mammary artery grafting and appear to be superior to interventional means. (C) 2000 by The Society of Thoracic Su rgeons.