OFF-BYPASS CORONARY-BYPASS GRAFTING VIA MINITHORACOTOMY USING MECHANICAL EPICARDIAL STABILIZATION

Background. Minimally or less invasive surgical coronary revasculariza tion has gained increasing interest along with new techniques and devi ces designed for easier and safer procedures. Until recently, it appea red questionable whether grafting techniques with avoidance of cardiop ulmonary bypass techniques would allow adequate results compared with conventional techniques using cardioplegic arrest. Methods. Since June 1996, minimally invasive direct coronary artery bypass grafting proce dures without cardiopulmonary bypass were intended in 24 patients (19 male, 5 female; age, 60.5 +/- 10.5 years) applying a special system (C ardioThoracic Systems, Inc) for internal mammary artery access and epi cardial surface stabilization approaching through an anterolateral min ithoracotomy. Neither video-assisted preparation nor additional pharma cologic stabilization was applied. Concomitant risk factors and associ ated comorbidity were frequent. Results. The procedure was completed i n 23 patients, grafting the left anterior descending coronary artery ( n = 21) or diagonal branches (n = 3, 1 sequential) as scheduled. In 1 case with internal mammary artery dissection, cardiopulmonary bypass a nd sternotomy became necessary. Simultaneous carotid endarterectomy wa s performed in 1 patient. There were two episodes of intraoperative ve ntricular fibrillation; no other major complications occurred. Postope rative evaluation was obtained in 16 patients (15 by angiography, 1 by Doppler echocardiography) so far and revealed adequate graft function and patency. Conclusions. Using specially designed instruments for in ternal mammary artery access and epicardial surface stabilization, min imally invasive direct coronary artery bypass grafting procedures via a minithoracotomy avoiding cardiopulmonary bypass techniques may be ap plied safely and successfully, even in increased risk constellations. (C) 1997 by The Society of Thoracic Surgeons.