Related Experiment Videos
Early experience with minimally invasive direct coronary artery bypass grafting with the internal thoracic artery
J R Doty1, J D Fonger, J D Salazar
1Divisions of Cardiac Surgery, Sinai Hospital at Baltimore and Washington Adventist Hospital, Takoma Park, Md, USA.
Insights
Minimally invasive direct coronary artery bypass using the internal thoracic artery offers excellent symptom relief for anterior heart disease. This approach avoids sternotomy and cardiopulmonary bypass, with a low reintervention rate.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Bypass Grafting
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) is a surgical technique performed without sternotomy or cardiopulmonary bypass.
- It utilizes the internal thoracic artery for arterial revascularization of the anterior heart surface.
- MIDCAB is applicable in both primary and reoperative surgical cases.
Purpose of the Study:
- To evaluate the efficacy and outcomes of anterior minimally invasive direct coronary artery bypass grafting using the internal thoracic artery.
- To assess the technique's applicability in patients with specific coronary artery disease patterns.
Main Methods:
- 162 patients with coronary artery disease affecting 1-2 anterior coronary distributions underwent MIDCAB.
- The internal thoracic artery was used to graft target coronary vessels via a small anterior thoracotomy.
- Anastomosis was facilitated by local coronary occlusion and handheld stabilization under partial heparinization.
Main Results:
- The left anterior descending artery was the most common target (88%).
- Early mortality was 4.9%, with 96% of patients experiencing symptom resolution at 12-month follow-up.
- A 5.6% reintervention rate for graft issues was observed during follow-up.
Conclusions:
- Anterior MIDCAB with the internal thoracic artery effectively bypasses the need for sternotomy, aortic manipulation, and cardiopulmonary bypass.
- The procedure demonstrates a low reintervention rate and excellent short-term anginal symptom relief.
- Further follow-up is necessary to ascertain long-term graft patency and patient survival rates.
Objective:
Minimally invasive direct coronary artery bypass is performed under direct vision without sternotomy or cardiopulmonary bypass. The technique can be used in both primary and reoperative cases by employing the internal thoracic artery to perform arterial revascularization of the anterior surface of the heart.
Methods:
Patients were selected who had significant coronary artery disease limited to 1 or 2 coronary distributions on the anterior surface of the heart. Coronary target vessels were grafted with the internal thoracic artery through a small anterior thoracotomy. After partial heparinization the anastomosis was facilitated by local coronary occlusion and handheld stabilization.
Results:
Between August 1994 and July 1997, 162 patients underwent minimally invasive direct coronary artery bypass grafting with the internal thoracic artery. The left and right internal thoracic arteries were used for grafting of the left anterior descending artery in 142 patients (88%), the proximal right coronary artery in 7 patients (4%), existing saphenous vein grafts in 5 patients (3%), and diagonal branches in 2 patients (1%). Sequential grafting with the left internal thoracic artery was performed in 2 patients (1%) and bilateral internal thoracic artery grafting was performed in 4 patients (3%). Eight patients (4.9%) died within 30 days after the operation, 3 of cardiac causes. Seven additional patients died during the follow-up period. Nine patients (5.6%) required reintervention for graft stenosis or occlusion during follow-up. Of 141 patients seen 2 or more weeks after the operation, 135 (96%) had resolution of their anginal symptoms at a mean follow-up of 12 months (range 0-31 months).
Conclusions:
Anterior minimally invasive direct coronary artery bypass grafting with the internal thoracic artery avoids the risks of repeated sternotomy, aortic manipulation, and cardiopulmonary bypass. There was a low rate of reintervention, and patients had excellent resolution of anginal symptoms. Postoperative length of stay was comparatively short, and continued follow-up will be essential to evaluate long-term graft patency and patient survival.