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.