Limited access myocardial revascularization. A preliminary report

A technique of limited access, direct vision surgery for performing coronary artery bypass grafting with the internal mammary artery is presented in this preliminary report. The procedure is performed without cardiopulmonary bypass. To gain access to the left (or right) coronary artery and the mammary artery, segments of the 3rd and 4th costal cartilages are removed. Before the pericardium is opened, the mammary artery is dissected distally under the 5th costal cartilage and proximally under the 3rd costal cartilage to the level of the 2nd costal cartilage. If the left anterior descending coronary artery is suitable for bypass, it is dissected and the bypass graft is placed. Limited access coronary bypass has been completed successfully in 8 of our first 9 patients. All 9 patients have had relief of anginal pain. This experience proves that coronary bypass operations can be performed in selected lesions without a quiet, bloodless field, thus avoiding the potential complications of cardiopulmonary bypass.