MINIMALLY INVASIVE CORONARY-ARTERY BYPASS-GRAFTING - ON THE BEATING HEART AND VIA LIMITED ACCESS

Minimally invasive coronary artery bypass grafting (MICABG) may be ach ieved by arterial grafting on the beating heart, without cardiopulmona ry bypass, and by operations via limited access. The Second Utrecht MI CABG Workshop held October 4-5, 1996, focused on beating-heart coronar y immobilization, limited-access thoracoscopic and direct-vision mobil ization of the internal mammary artery, limited-access left anterior d escending coronary artery grafting, and, finally, facilitated distal a nastomosis techniques. It has yielded 33 reports in this supplement. T he combined, cumulative experience of a number of participants exceede d 3,000 beating-heart cases, including more than 1,000 with arterial g rafting through limited access. The average number of anastomoses per patient ranged from 1.0 to 2.0. Therapeutic strategies are evolving, a nd dedicated instrumentation is being developed. Randomized clinical t rials with angiographic follow-up are required to establish that the r eduction in invasiveness of coronary bypass grafting is not achieved a t the expense of suboptimal quality of the arterial graft and the dist al anastomosis. (C) 1997 by The Society of Thoracic Surgeons.