MINIMALLY INVASIVE VERSUS CONVENTIONAL REOPERATIVE CORONARY-ARTERY BYPASS

Background. Conventional reoperative (redo) coronary artery bypass gra fting (CABG) is associated with significant morbidity. This retrospect ive study compared perioperative outcomes of conventional single-vesse l redo CABG versus redo CABG done by a minimally invasive technique. M ethods. Group A consisted of 23 consecutive patients from September 19 95 to July 1996 who underwent single vessel redo CABG of the left ante rior descending artery with the left internal mammary artery using a l imited anterior thoracotomy without cardiopulmonary bypass; group B co nsisted of 12 consecutive patients from November 1984 to July 1994 who underwent the same procedure using a median sternotomy with cardiopul monary bypass. The two groups were similar with regard to age, sex, pr eoperative ejection fraction, and risk stratification. Results. Mortal ity, cerebrovascular accidents, myocardial infarctions, and reoperatio ns for bleeding were not significantly different between the groups. H owever, the patients in group A had significant reductions in atrial f ibrillation, time to extubation, transfusions required, and length of cardiac recovery and hospital stay. With a mean of 12 +/- 6 months of follow-up, 87% of the patients in group A (20 of 23) are alive and asy mptomatic. Actuarial survival rates for the patients in group B at 1, 2 and 10 years are 83%, 83%, and 72%, respectively. Conclusions. Minim ally invasive single-vessel redo CABG can be performed safely and may reduce the morbidity associated with conventional single-vessel redo C ABG. (C) 1997 by The Society of Thoracic Surgeons.