Minimally invasive direct coronary artery bypass for completely obstructed left anterior descending coronary artery

We evaluated the efficacy of minimally invasive direct coronary artery bypass (MIDCAB) using the left internal thoracic artery (LITA) in patients with completely obstructed left anterior descending coronary artery (LAD).

Ten patients undergoing MIDCAB for LAD stenosis were enrolled in this study. These patients were all men aged 45 to 69 years, and were divided into two groups, one showing complete LAD obstruction (n=5, Group A), and one about 90% stenosis of the LAD (n=5, Group B).

The internal size of the LAD at the anastomosis site was significantly smaller in Group A than in Group B, and the time required for graft anastomosis in Group A was significantly longer. Total operation time, intubation time after operation, perioperative bleeding, total blood transfusion, max CK-MB, and hospital stay did not significantly differ between the two groups. Postoperative coronary angiography revealed good graft patency in both groups, however, one Group A patient had graft obstruction.

The MIDCAB procedure appears useful even in our patients with completely obstructed LAD, despite the long anastomosis time. However, the indications for this procedure are limited by any perceived difficulty in harvesting the LITA by indirect vision or in performing the anastomosis based on the size or quality of the LAD. Intensive preoperative angiography evaluation is essential and conversion to a median full-sternotomy is necessary for cases in which we cannot confirm the feasibility of MIDCAB.