Video-Assisted Minimally Invasive Coronary Artery Bypass Grafting — The Early and Late Results

(#2001-6887 ... June 27, 2001)

Marek Cisowski,¹ Rafik Abu Samra,¹ Wojciech Kruczak,² Wodzimierz Morawski,¹ Andrzej Bochenek¹

¹Department of Cardiac Surgery, Silesian School of Medicine, Katowice, Poland
² Department of Cardioanaesthesiology, Silesian School of Medicine, Katowice, Poland

Presented at the Fourth Annual Scientific Meeting of the International Society for Minimally Invasive Cardiac Surgery, June 27-30, 2001, Munich, Germany.

ABSTRACT

Introduction: Minimally invasive direct coronary artery bypass (MIDCAB) is the method of surgical treatment in patients (pts) with left anterior descending artery (LAD) lesion. Left internal thoracic artery (LITA) is the graft of choice for LAD grafting due to excellent long-term patency. The implementation of the video-assisted LITA harvesting allows harvesting it completely and atraumatically and lessens chest wall trauma and reduces length of minithoracotomy.

Materials and Methods: Between June 1998 and December 2000, we performed 147 MIDCABs (108 male, 39 female, mean age 57.5 ± 18.1 years). In all the cases the video-assisted LITA harvest was employed. The LITA-LAD anastomosis was performed through left minithoracotomy without use of the cardiopulmonary bypass. The criteria of eligibility to MIDCAB were: type B or C lesion in 6th or 7th segment, restenosis after PTCA and/or stenting.

Results: There were no early and late deaths. Baseline CCS class was 1.8 ± 0.7 versus 1.1 ± 0.3 after 6 month (p<0,001). Follow-up period was 3 to 32 months. Coronary control angiography was performed in 95 pts (64.6%). Angiographic studies showed patent LITA-LAD graft in 93 pts (98%). We showed good quality of anastomosis in 91 pts (95.8%). Conversion to sternotomy (2.8%) and complications rates (4.1%) were low and did not have the influence on composite end-point (death, myocardial infarction and repeated revascularization).

Conclusion: The MIDCAB procedure is safe and effective treatment of the proximal LAD lesion. MIDCAB with video-assisted LITA harvesting allows reducing operative trauma improves the quality of anastomosis and reduces postoperative pain