MIDCAB: Impact of Epicardial Stabilization Upon Outcomes

(#1999-9158 ... March 5, 1999)

E. Charles Douville, MD, John R. Handy, Jr, MD, Andrew C. Tsen, MD, Gary Y. Ott, MD, Mark Gilbert, PA-C, James W. Asaph, MD

The Oregon Clinic and Providence Portland Medical Center, Portland, OR, USA

ABSTRACT

Background: Minimally invasive direct coronary artery bypass (MIDCAB) has been criticized as compromising anastomotic patency. Epicardial mechanical stabilization devices purportedly facilitate left internal mammary artery (LIMA) anastomosis, thereby enhancing patency and outcome.

Methods: From June 1996 through January 1999, 39 patients underwent MIDCAB via a small left anterior thoracotomy for revascularization of the left anterior descending coronary artery (LAD) without cardiopulmonary bypass (CPB). Immediate postoperative coronary angiography was performed on 38 of the patients.

Results: Group 1 consisted of 11 patients who were operated upon without epicardial stabilization. Mean age was 64 years. Two had undergone previous coronary artery bypass (CAB). Predicted mortality was 4.3%. Angiographic anastomotic patency was 60%. Revisions on CPB in three cases increased LIMA patency to 90%. There was one intra-operative death. Average length of stay (LOS) was 5.4 days. Group 2 consisted of 28 patients operated on with mechanical epicardial stabilization. Predicted risk of mortality was 4.4%. Mean age was 66 years. Twelve had undergone previous CAB. Anastomotic patency at angiography was 97.4%. There were no intra-operative deaths and mean LOS was 3.0 days.

Conclusions: We conclude that mechanical epicardial stabilization has transformed the MIDCAB operation into one that offers excellent early patency and clinical outcomes. This operation is of particular value for revascularization of the anterior coronary circulation in patients with previous CAB; clinical results are significantly better than predicted for standard redo-CAB.

AUTHOR/ARTICLE INFORMATION

Reprint requests to: E. Charles Douville, MD, Division of Cardiothoracic Surgery, The Oregon Clinic, P.C., 507 NE 47th Avenue, Portland OR 97213; Email: ecdouville@orclinic.com

Submitted on: February 18, 1999

Keywords: Stabilizer, mechanical stabilizers, stabilization, off-pump, coronary artery bypass grafting (CABG), minimally invasive, less invasive, OPCAB, MIDCAB, mortality, graft patency, angiography, stenosis