Multivessel Minimally Invasive Coronary Surgery With Endoscopic Support

(#1999-964 ... May 21, 1999)

G.P. Vlassov, MD, PhD, A.S. Ermolov, MD, PhD, K.S. Deyneka, MD, N.O. Travine, MD, PhD, M.B. Belinskiy, MD, S.D. Klimovskiy, MD, I.V. Zhuravlev, MD

Sclifosovsky Research Emergency Center, Moscow, Russia

ABSTRACT

Background: Interest in minimally invasive coronary artery bypass (MICAB) grafting and the MICAB experience have been increasing. The purpose of this study was to develop the multivessel minimally invasive coronary revascularization technique and to estimate the effectiveness of the endoscopic support in this operation.

Methods: From January 1998 through April 1999, 190 patients (ages 38 to 72 years) underwent coronary revascularization without cardiopulmonary bypass. Among them, 69 patients (55 males, 14 females) underwent minimally invasive coronary revascularization, from 1 to 3 vessels, through minithoracotomy and ministernotomy with endoscopically dissected internal mammary artery, gastroepiploic artery, and composite grafts. Preoperative risk factors included unstable angina (n = 15), reoperations (n = 8), low ejection fraction (n = 14), renal insufficiency (n = 4), chronic obstructive pulmonary disease (n = 6), cerebrovascular accident (n = 2), diffuse atherosclerosis (n = 4) and diabetes mellitus (n = 7).

Results: The operative mortality was 1.5% (1/69). Morbidity included wound infections (n = 1), reoperation for management of bleeding (n = 1), acute graft occlusion (n = 1), perioperative miocardial infarction (n = 1). The number of grafts placed in 69 patients was as follows: single, 54; double, 10; triple, 5. Postoperative angiography and Doppler flow assessment of the coronary anastomoses performed in 22 patients (30%) showed that 97% were patent.

Conclusions: The minimally invasive direct coronary artery bypass grafting operation is safe and effective. Endoscopic support makes the use of minimally invasive technology possible in patients with multivessel coronary disease and makes this operation less traumatic.

AUTHOR/ARTICLE INFORMATION

Presented at the Second Annual Meeting of the International Society for Minimally Invasive Cardiac Surgery, Palais dés Congres Paris, France, May 21-22, 1999.

Reprint requests to: Dr. Deyneka Constantine S., 123423 Rossia, Moskva, D.Bednogo, 17-3-222, Russia; Fax: 007-095-1929103; E-mail: dndkosty@cityline.ru

Submitted on: Peer reviewed and accepted at the International Society for Minimally Invasive Cardiac Surgery's 2nd Annual Meeting and Scientific Sessions, Paris, France, May 21-22 1999.

Keywords: multivessel MIDCAB, endoscopic coronary surgery