ANASTOMOTIC COMPLICATIONS IN MINIMALLY INVASIVE CORONARY-BYPASS GRAFTING

Background. Anterior wall myocardial revascularization through a left anterior minithoracotomy is an increasingly accepted procedure. Techni cal failure at the anastomotic site, promoting persistent or recurrent angina, is known to occur and may be underrecognized, This report sum marizes the incidence of technical failure in an initial clinical expe rience and describes potential causes of early postoperative complicat ions. Methods. Between December 1995 and May 1996, 15 patients underwe nt left internal mammary artery-to-left anterior descending artery rev ascularization without extracorporeal circulation. The surgical indica tion was single-vessel coronary disease in all patients. We exposed th e left anterior descending artery target site through a 10-cm left ant erior fourth space thoracotomy. The fourth costal cartilage was resect ed and the left internal mammary artery was harvested under direct vis ualization. Two 4-0 polypropylene sutures snared in tourniquets proxim al and distal to the anastomotic site were used to obtain a bloodless field and stabilization of the left anterior descending artery. Result s. All patients had procedures initially deemed successful based on di sappearance of angina or postoperative transthoracic Doppler examinati on of the internal mammary artery 3 to 5 days postoperatively. However , 3 patients presented with recurrent angina at 2, 6, and 8 weeks. Ang iography or direct visualization at operation demonstrated the technic al complication (stenosis at the anastomotic site in 2 and snare injur y in the native vessel in 1). Two patients required reoperation. Concl usions. Initial results with minimally invasive coronary bypass grafti ng have generated great enthusiasm worldwide, but there is no consensu s on how the procedure should be performed. These results suggest that a nonstabilized anastomosis results in an unacceptable failure rate. Furthermore, sutures encircling the left anterior descending artery sh ould not be used for vessel stabilization as injury of the artery may occur. (C) 1997 by The Society of Thoracic Surgeons.