VATS FOR COMPLETE DISSECTION OF LIMA IN MINIMALLY INVASIVE CORONARY-ARTERY BYPASS-GRAFTING

Background. The aim of this work is to report our initial experience w ith minimally invasive coronary artery bypass grafting, using video-as sisted thoracic surgery (VATS) to facilitate the operation and provide complete dissection of the left internal mammary artery (LIMA). Metho ds. Of 44 scheduled patients, 43 patients, 30 (69.8%) male, ranging in age from 31 to 83 years (60.8 +/- 12.0 years), with a severe lesion i n the anterior descending artery, were operated upon. An 8-cm left ant erior minithoracotomy was performed at the fourth intercostal space. T hrough this incision the optical device for video-assisted thoracic su rgery as well as the surgical instruments were placed to provide compl ete LIMA dissection. This permits dissection until the subclavian regi on, allowing for anastomosis without tension or distortion. Bypass cir culation was not used, and the cardiac rate was decreased with the use of intravenous beta-blockers. For LIMA-to-anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg o f heparin was administered intravenously. Results. Video-assisted thor acic surgery provided a complete dissection of LIMA. The 43 patients p resented satisfactory postoperative progress, being released from the hospital between 2 and 12 days after their operation, with a mean of 4 days. The patients have remained asymptomatic during a period that ra nged from 1 to 13 months (6.3 +/- 3.5 months). During the follow-up, t here was one death as a result of stroke and pneumonia 2 months after the release from the hospital. Conclusions. The use of video-assisted thoracic surgery through thoracotomy allows the LIMA dissection withou t the necessity of other incisions. The procedure also permitted more ample dissection of LIMA when compared with minithoracotomy without vi deo-assisted thoracic surgery. (C) 1997 by The Society of Thoracic Sur geons.