Experiences with a minimally invasive surgical technique for the treatment of coronary artery multivessel disease in 100 patients

Objective: The treatment of coronary single vessel disease under minimally invasive surgical conditions was followed by the treatment of coronary multivessel disease using a new technique. Methods: using this technique 100 patients (80 male, 20 female, median age 61.0 ± 8.9 years, ranged from 39 to 82 years) with coronary single vessel disease, double vessel disease or multivessel disease were treated between November 1996 and December 1997. Via a small (6-9 cm) left lateral chest incision in the second or third intercostal space, the left internal thoracic mammary artery (LIMA) was harvested and access to the central portion of the heart including the ascending aorta was obtained. In parallel, saphenous vein segments were harvested. Arterial cannulation was instituted via the ascending aorta, thus avoiding retrograde flow. In all patients except three the LIMA was used for the left anterior descending artery (LAD). In addition vein grafts were used for revascularization of the other coronary arteries. All cardiac anastomoses were performed during cardioplegic arrest after external aortic cross clamping and antegrade application of cardioplegia. Results: No death or intraoperative complications were observed in this series. The median hospital stay was 6.0 ± 1.4 days (median ± SEM). Postoperative complications were reexplored for bleeding (n=1), delayed wound healing (n=2), wound infections (n=4), lymphatic fistulas (n=4), and a chest wall hernia (n=1). Conclusions: This minimally invasive surgical technique presents a safe alternative to conventional coronary artery surgery avoiding sternotomy related complications and decreasing hospital stay and morbidity.