Minimally invasive coronary artery bypass grafting without cardiopulmonary bypass: Early experience and follow-up

Background. There is renewed interest in coronary artery bypass grafting without cardiopulmonary bypass using the anterolateral minithoracotomy approach. We evaluated 209 patients who underwent minimally invasive direct coronary artery bypass grafting using an anterolateral minithoracotomy. The anastomosis was performed under direct vision on the beating heart without using cardiopulmonary bypass. Methods. The procedure was performed using a 6- to 9-cm left (or right) anterolateral thoracotomy for internal thoracic artery graft harvesting and anastomosis. Different devices were used for local immobilization. In 195 patients a single internal thoracic artery to left anterior descending coronary artery bypass was performed, in 3 patients a single right internal thoracic artery to right coronary artery bypass, and in 11 patients the radial artery was used together with the internal thoracic artery as a T-graft. Results. Conversion to sternotomy or cardiopulmonary bypass was necessary in 10 (4.7%) patients. Intraoperative myocardial infarction was observed in 4 patients (1.9%). Early postoperative redo operation was necessary in 5 patients (2.4%). Mortality was 0.47%. Postoperatively, 191 patients (91.3%) underwent angiography for graft patency control. The overall patency rate was 97.3%. Minor stenosis of the internal thoracic artery graft was observed in 18 patients (9.4%); moderate stenosis was observed in 5 patients (2.6%). Midterm angiographic follow-up after 6 months was performed in 58 patients. The patency rate was 98.2%. One patient with severe symptomatic stenosis (1.7%) underwent reoperation. Conclusions. With the help of the local immobilization systems off-pump coronary artery bypass grafting was safely performed through a minithoracotomy. The incidence of intraoperative and postoperative complications was low and follow-up showed good results. Thus, minimally invasive direct coronary artery bypass grafting is an excellent technique for arterial revascularization in patients having symptomatic left anterior descending coronary artery disease.