CORONARY-BYPASS GRAFTING VIA MINITHORACOTOMY ON THE BEATING HEART

Background. Recently the availability and the superiority of less inva sive coronary artery bypass grafting on some selected groups of patien ts in the meaning of patient comfort and short hospital stay has been shown by some authors. We present here the clinical results of 40 pati ents operated on by minithoracotomy incision on the beating heart with out using cardiopulmonary bypass mostly harvesting the left internal t horacic artery by videothoracoscopic assistance.Methods. Between March 1996 and September 1996, 40 patients were operated on by harvesting t he left internal thoracic artery mostly by video-assisted thoracoscopy and performing bypass through a minitoracotomy incision. Two patients in whom the procedure was switched to conventional technique were not included in this series. Nine of the patients were female and the res t were male. The mean age was 43.2 +/- 7. Results. Left internal thora cic arteries were harvested by video-assisted thoracoscopy completely in 11 patients, incompletely in 24 patients (the harvesting was comple ted by direct vision afterwards), and under direct vision in 5 through a mini-anterior thoracotomy incision. Thirty-six patients received a bypass graft to left anterior descending coronary artery only, whereas 4 received a diagonal branch graft also. Left internal thoracic arter ies were used to bypass the left anterior descending coronary artery d irectly in 38 patients. The left internal thoracic artery was injured in the middle portion during harvesting in 1 of the remaining 2 patien ts. The length was not enough in the other. A short saphenous vein gra ft was interposed between the left internal thoracic artery and the le ft anterior descending coronary artery in these 2 patients. There was no mortality. One patient had perioperative myocardial infarction. We did not see serious morbidity except one lung injury due to the trocha r. Conclusions. The results obtained from our experience suggest that coronary artery bypass grafting by minithoracotomy could be applied ef fectively and safely without overwhelming additional risk to the patie nt. Furthermore, it has some advantages in reducing operative trauma a nd cost and also improving patient comfort. (C) 1997 by The Society of Thoracic Surgeons.