MINIMALLY INVASIVE CORONARY REVASCULARIZATION THROUGH PARASTERNAL INCISIONS WITHOUT CARDIOPULMONARY BYPASS

Background. We report the results of minimally invasive coronary revas cularization without cardiopulmonary bypass through miniparasternal in cisions. Methods. This procedure was performed in 40 patients with dis ease in the left anterior descending, first diagonal, and right corona ry arteries. After a 5- to 7-cm left vertical parasternal incision and removal of two costal cartilages, the left internal mammary artery wa s harvested up to the 2nd rib. The left anterior descending artery was occluded by means of two polydioxanone monofilament sutures. The anas tomosis was performed with one 7-0 Prolene suture while the heart was beating. In 4 cases the left internal mammary artery was used as a seq uential graft to the left anterior descending artery and the first dia gonal artery. In 14 cases the right coronary artery was grafted with t he right internal mammary artery through a right parasternal incision. Postoperatively, 95% of the patients underwent angiographic assessmen t of the anastomoses. Results. We performed 52 anastomoses (34 to the left anterior descending artery, 4 to the first diagonal artery, and 1 4 to the right coronary artery). The mortality was 0% and the morbidit y included postoperative bleeding (5%), acute renal failure (2.5%), at rial fibrillation (2.5%), and wound infection (5%). No patient had ven tricular arrhythmias or circulatory problems during or after the opera tion. Two patients (5%) with right internal mammary artery-to-right co ronary artery grafting had graft failure that required a redo operatio n. Conclusions. Small vertical parasternal incisions may be an alterna tive approach for single and multiple coronary revascularization, with a low incidence of intraoperative cardiac complications. The applicat ion of this approach to the right coronary artery, however, carries ad ditional technical difficulties, and careful patient selection may be required to achieve optimal results. (C) 1997 by The Society of Thorac ic Surgeons.