Minimally invasive coronary artery bypass surgery without cardiopulmonary bypass

To report on the initial results of minimally invasive direct coronary artery bypass surgery (MIDCAB) without cardiopulmonary bypass. This is a potential alternative to conventional coronary artery bypass graft surgery, recently introduced to Australia.

Prospective survey of patient data.

Royal Melbourne Hospital campus, Melbourne, Victoria, July 1996 to June 1997.

The first 23 consecutive patients to have a MIDCAB procedure without cardiopulmonary bypass via a small left thoracotomy. The left anterior descending coronary artery was revascularised with the left internal mammary artery. All patients had either recurrent stenosis after previous angioplasty or anatomy unsuitable for angioplasty.

Operative morbidity and mortality; graft patency; and patient symptom relief and reoperation rates.

Mean age of patients was 57.9 years (range, 29-81), and mean follow-up was 4.0 months (range, 1-10). There was no operative mortality, cardiac infarction or stroke. Mean postoperative stay in the Intensive Care Unit was 30.7 hours and in hospital, 5.3 days. Only one patient needed a blood transfusion (packed red cells). Initial patency of the grafts was confirmed by either angiography (five) or continuous pulse-wave Doppler (23). One patient underwent angioplasty for a stenosis distal to the anastomosis, and two patients (9%) required reoperation for recurrent angina.

MIDCAB can be performed safely, and patient recovery is faster than after conventional coronary artery surgery.