VIDEO-ASSISTED CORONARY-BYPASS GRAFTING ON THE BEATING HEART

Background. Concepts to make coronary artery bypass operations less in vasive include minimization of access incisions, elimination of cardio pulmonary bypass, and no manipulation of the aorta. A spectrum of mini mally invasive coronary bypass procedures now exist that eliminate the median sternotomy (port-access approach), cardiopulmonary bypass (''o ff-pump bypass''), or both (minimally invasive direct coronary artery bypass procedure). Although all have advantages in decreasing the morb idity of myocardial revascularization, significant limitations exist i ncluding surgeon experience, access, exposure, visualization, hemodyna mic support, and technique of anastomosis. Methods. In an attempt to e xtend the applicability of the current minimally invasive techniques, efforts are being made both to extend the indications for the procedur e as well as to modify the technical aspects. Our current experimental protocol involves a ports-only approach with three-dimensional video imaging, percutaneous Hemopump circulatory support, Octopus coronary i mmobilization, and an endoscopically sutured coronary anastomosis. Res ults. In a series of animal studies we have been able to successfully accomplish a totally endoscopic coronary artery bypass procedure on a beating heart without cardiopulmonary bypass. Conclusions. Although en doscopic coronary artery bypass without cardiopulmonary bypass is poss ible, many technical challenges remain. Three-dimensional video imagin g, wall motion immobilization and presentation, and an axial-flow devi ce can facilitate the procedure. Future enabling technology including motion robotics and nonvisual imaging systems may ultimately further m inimize the invasiveness of surgical myocardial revascularization. (C) 1997 by The Society of Thoracic Surgeons.