[Minimally invasive coronary artery surgery]

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Coronary Artery Bypass Grafting

Background:

• Growing interest in minimally invasive techniques for coronary artery surgery.
• Focus on left internal mammary artery (LIMA) to left anterior descending (LAD) artery grafting.
• Exploration of beating heart procedures without cardiopulmonary bypass.

Purpose of the Study:

• To report the initial experience with minimally invasive coronary artery surgery.
• To evaluate the feasibility and outcomes of LIMA-to-LAD grafting via left anterior mediastinotomy.
• To assess the safety and efficacy of this technique in a small patient cohort.

Main Methods:

• Analysis of 11 patients (48-79 years) with single-vessel disease undergoing LIMA-to-LAD bypass.
• Minimally invasive left anterior mediastinotomy without cardiopulmonary bypass.
• Pharmacological control of hemodynamics and ischemic preconditioning for anastomosis.
• Intraoperative Doppler and postoperative arteriography for graft patency assessment.

Main Results:

• Successful LIMA-to-LAD anastomosis in all patients.
• No hospital mortality, perioperative myocardial infarction, or bleeding complications.
• All patients extubated in OR, discharged by postoperative day 3.
• Graft patency confirmed in all patients; 10/11 free of angina at 11.6-month follow-up.
• One patient required angioplasty for anastomotic stenosis.

Conclusions:

• Minimally invasive left anterior mediastinotomy is a viable approach for LIMA-to-LAD grafting without cardiopulmonary bypass.
• This technique facilitates shorter hospital stays and earlier recovery.
• Further research with larger cohorts and longer follow-up is needed to establish its definitive role in coronary artery disease treatment.