Less invasive arterial CABG on a beating heart.

BACKGROUND: Competitive status of percutaneous transluminal coronary angioplasty and stenting has stimulated an interest in minimally invasive direct coronary artery bypass grafting.

METHODS: Between April 1994 and September 1996,156 patients with a mean age of 67 +/- 10 years have undergone minimally invasive direct coronary artery bypass grafting via minithoracotomy, subxiphoid incision, or both with internal mammary artery, right gastroepiploic artery, and radial artery grafting using local coronary occlusion on a beating heart with immobilization of the coronary artery target sites with traction sutures and mechanical regional cardiac wall immobilization platform.

RESULTS: Morbidity included wound infection (3), reoperation for bleeding (5), atrial fibrillation (12), central nervous system complication (1), and perioperative myocardial infarction (5). Cardiac-related operative mortality was 1.2% (2/156). Predominantly single grafting was done in 128 patients. Routine angiographic and Doppler echocardiographic flow assessment of anastomotic patency showed an overall patency rate of 92%. In 52 recent consecutive patients in whom the regional cardiac wall mechanical stabilization platform was used, the patency rate of the left internal mammary artery-to-left anterior descending coronary artery graft was improved to 96.2%. With a mean followup of 9.2 +/- 7.4 months, cardiac event-free interval (percutaneous transluminal coronary angioplasty, reoperative coronary artery bypass grafting, or death) in 111 patients was 91%.

CONCLUSIONS: Minimally invasive direct coronary artery bypass grafting is safe and effective with good early and midterm clinical results, especially with left internal mammary artery-to-left anterior descending coronary artery grafting via minithoracotomy. Regional cardiac wall immobilization of coronary artery target sites enhances the early graft patency in a predictable manner (96.2%), and this method should be an essential part of all minimally invasive direct coronary artery bypass graft operations with left internal mammary artery-to-left anterior descending artery grafts via minithoracotomy. Further study is required to establish the long-term efficacy of minimally invasive direct coronary artery bypass grafting and the treatment of coronary artery disease.