MAMMARY-CORONARY ARTERY ANASTOMOSIS WITHOUT CARDIOPULMONARY BYPASS THROUGH A MINITHORACOTOMY

Background. Coronary artery bypass grafting has been based on cardiopu lmonary bypass, myocardial protection, and the median sternotomy. The recent concept of minimally invasive coronary artery bypass grafting i n selected patients has dramatically affected surgical management of c oronary artery disease. Coronary artery bypass grafting of anterior co ronary arteries with in situ internal mammary artery through a limited anterior thoracotomy is a procedure that is gaining acceptance. Metho ds. Fifty-one patients were operated on by minithoracotomy and direct coronary artery bypass grafting without cardiopulmonary bypass. Left i nternal mammary artery-to-left anterior descending coronary artery ana stomosis was done in 50 patients, and in 1 patient, left internal mamm ary artery-to-left anterior descending artery and right internal mamma ry artery-to-right coronary artery anastomoses were constructed throug h bilateral minithoracotomies. Left anterior minithoracotomy through t he fourth intercostal space and right anterior minithoracotomy through the fifth intercostal space were used for left internal mammary arter y and right internal mammary artery dissection, respectively. With thi s approach, a 4- to 6-cm length of mammary artery was easily dissected . Mammary-to-coronary anastomosis was performed on a beating heart wit hout cardiopulmonary bypass through window pericardiotomy. Results. Tw enty-five patients were extubated in the operating room and 26 in the intensive care unit 4 to 6 hours after operation. None of these patien ts required blood transfusion or inotropic support. Postoperative pred ischarge angiography in 42 patients revealed adequate mammary-to-coron ary flow in 40 patients. Doppler flow studies were also in accordance with angiographic findings. Forty-five patients are in our regular fol low-up (mean follow-up, 6.23 +/- 1.34 months); 44 of them are in funct ional class I. Conclusion. In our experience minithoracotomy is a safe , simple, and minimally invasive procedure. Favorable cost/benefit rat io has been achieved owing to no early or late mortality and minimal e arly morbidity. Postoperative angiography and Doppler flow study revea led excellent predictive long-term results. (C) 1997 by The Society of Thoracic Surgeons.