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Eur J Cardiothorac Surg 1998;14:S13-S19
© 1998 Elsevier Science NL

Less-invasive coronary artery bypass grafting: different techniques and approaches

Clinic of Cardiac Surgery, University of Leipzig, Heartcenter, Leipzig, Germany

^* Corresponding author. Tel.: +49 341 8651421; fax: +49 341 8651452.

Objective: The aim of this study was to compare four different techniques for less-invasive coronary artery bypass surgery with and without cardiopulmonary bypass (CPB) in terms of feasibility as well as in terms of the intra- and postoperative course. Methods: One hundred and fourteen patients were divided into four groups, according to the surgical technique. Group I: minithoracotomy, internal thoracic artery (ITA) harvesting and anastomosis under direct vision using cardiopulmonary bypass (CPB) on the fibrillating heart (n=31). Group II: sternotomy and beating heart without CPB (n=13). Group III: MIDCAB with CPB and cardioplegic cardiac arrest using endo-aortic balloon-occlusion, Port Access system (n=9). Group IV: MIDCAB on the beating heart without CPB (n=61). In total, 104 single and ten double graft procedures were performed using the radial artery T-graft technique in seven cases (groups III and IV). Results: Harvesting of the ITA graft took 41±16.2 min in group I and could be reduced to 31±8.3 min in group IV by the use of a specially-designed retractor. Complications were: death (n=1, group I), myocardial infarction, (n=1, group I), early occlusion of the graft (n=1, group IV), early stenosis of the anastomosis (n=2, groups I and IV), late stenosis of the anastomosis (n=1, group IV), thrombosis of the femoral vein (n=1, group III). Postoperative ventilation, ICU and hospital stay were similar among groups. Conclusions: Based on our results, the following strategy has been developed: MIDCAB without CPB is the preferred technique for one-vessel graft procedures to the left anterior descendens (LAD) or RCA. The Port Access system (with CPB) is reserved as a second option for young patients requiring multiple-vessel grafting to the left coronary circulation (LAD/CX) and as a backup to avoid conversion. Sternotomy and an off-pump technique is used for single-vessel or multiple-vessel graft procedures in selected patients (emergency procedure, acute myocardial infarction, in the very obese).

Key Words: Minimally-invasive direct coronary artery bypass • Minimally invasive • Less invasive • Coronary artery bypass