A xiphoid approach for minimally invasive coronary artery bypass surgery

Background. The premise for adopting minimally invasive cardiac surgery tec hniques for myocardial revascularization is to reduce the patient's morbidi ty without compromising the efficacy of conventional coronary artery bypass . However, opening the pleura has been a limitation of using these approach es. Aim: We used the xiphoid approach as an alternative to opening the pleu ra and to minimize pain after minimally invasive coronary artery bypass sur gery. Methods: We review our surgical experience in 55 patients who underwe nt minimally invasive direct coronary artery bypass (MIDCAB) surgery throug h a xiphoid approach between October 1997 and August 1999. Thoracoscopy (n = 31) or direct vision (n = 24) were used for internal mammary artery (IMA) harvesting. Mean patient age was 67 +/- 10 years and 65% were men. The mea n Parsonnet score was 23 10. Performed anastomoses included left IMA (LIMA) to the left anterior descending (LAD) artery (n = 53), LIMA-to-LAD and sap henous vein graft from the LIMA to the right coronary artery (n = 1), and L IMA-to-LAD and right IMA (RIMA) to right coronary artery (n = 1). Results: Postoperative complications included atrial fibrillation (12%), acute nonin fectious pericarditis (12%), and acute renal failure (5%). Mean postoperati ve length of stay was 4 +/- 2 days. Angiography was performed in 16 patient s and demonstrated excellent patency of the anastomoses. There was no opera tive mortality. Actuarial survival was 98% in a mean follow-up period of 11 +/- 5 months. Conclusions: Minimally invasive coronary artery bypass can b e performed safely through a xiphoid approach with low morbidity, mortality , and a relatively short hospital stay.