MINIMALLY INVASIVE CORONARY-ARTERY BYPASS - A SERIES WITH EARLY QUALITATIVE ANGIOGRAPHIC FOLLOW-UP

Background. Notwithstanding the advantages offered by minimally invasi ve coronary bypass, valid concerns have been raised about the technica l accuracy of the distal anastomoses that can be fashioned can a beati ng heart. The main objective of our study was to undertake early and c omplete qualitative angiographic graft analysis in all patients underg oing this procedure. Methods. All enrolled patients (25) from January to October 1996 who had bypass done by one surgeon via left minithorac otomy (19) or median sternotomy (6) on a beating heart underwent posto perative angiography within 4 to 6 hours, These angiograms were then r eviewed for qualitative analysis and compared with a similar series do ne under conventional cardioplegic arrest. Results. There was 97.5% gr aft patency (28/29) and no anastomotic occlusions. One internal thorac ic artery was damaged. There was no mortality and no perioperative myo cardial infarctions. All patients are alive and symptom free. The foll ow-up if 100% complete and ranges from 15 days to 11 months. Of the 26 anastomoses that could be assessed, 21 (81%) were grade A and 5 (19%) were grade E. Tn comparison, 24/25 (96%) of the anastomoses fashioned on an arrested heart by the same surgeon were grade A (p = 0.175). Co nclusions. Minimally invasive coronary bypass can be tarried out effec tivity and safely in a select group of patients, and the development o f stabilizing devices and proper instrumentation should further improv e results. (C) 1997 by The Society of Thoracic Surgeons.