Minimally invasive coronary artery bypass grafting: One-year follow-up

Background: Use of the minimally invasive direct coronary artery bypass gra fting (MIDCAB) technique has been associated with excellent primary results , and sparing of resources has been assumed. There is, however, a limited a mount of information available concerning the results of mid-term follow-up . The purpose of this study was to present 1-year follow-up results of our first 130 consecutive MIDCAB patients. Methods: MIDCAB operations, defined as no sternotomy, no cardiopulmonary bypass, and no aortic manipulation wer e started in our clinic in February 1996. One hundred thirty patients requi ring invasive treatment of coronary artery disease who were not suitable fo r percutaneous transluminal angioplasty were included in this series. The m ain outcome measures were mortality, the need for subsequent invasive treat ment, and 1-year NYHA classification. Results: There was one hospital death , but during the first-year follow-up, four additional deaths occurred and three patients were reoperated on with conventional techniques. Five percut aneous transluminal coronary angioplasties (PTCAs) had to be performed, two because of anastomosic stenosis. Additionally, cardiac- or operation-relat ed symptoms caused a total of 27 hospital visits among 23 patients during t he first-year follow-up. Angiographic left internal thoracic artery (LITA)- left anterior descending artery (LAD) patency was 97.4% (37/38) (confidence interval [CI] ranged from 86.2% to 99.9%) at 3 months. After 1 year, 86.9% (113/130) of the patients were without symptoms. A clear improvement of th e follow-up results was observed to be associated with increased experience during the study period. Conclusions MIDCAB operations, after some experie nce, can be performed with relatively good outcome. However, special attent ion should be directed to determination of correct anastomosic site and to avoiding anastomosic stenosis. We also recommend extended mobilization of t he ITA and use of specific stabilizers.