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Minimally invasive direct coronary artery bypass: our experience with 32 patients
H C Suen1, R G Johnson, R M Weintraub
1Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Centre, Boston, MA 02215, USA.
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) is a safe and effective procedure. This study found no deaths or major complications in 31 patients undergoing MIDCAB surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery disease requires surgical intervention.
- Conventional coronary artery bypass grafting (CABG) involves cardiopulmonary bypass and a median sternotomy.
- Minimally invasive direct coronary artery bypass (MIDCAB) offers an alternative approach.
Purpose of the Study:
- To evaluate the safety and efficacy of minimally invasive direct coronary artery bypass (MIDCAB) surgery.
- To assess the outcomes of MIDCAB in patients with various degrees of coronary artery disease.
Main Methods:
- MIDCAB was performed in 31 patients without cardiopulmonary bypass via a small anterior thoracotomy.
- A novel coronary artery immobilizing and occluding device was utilized to facilitate anastomosis.
- Patient demographics, comorbidities, and procedural details were recorded.
Main Results:
- No post-procedure deaths, peri-operative myocardial infarctions, or strokes occurred.
- One patient required intra-operative conversion to conventional CABG.
- Two patients needed conversion post-operatively due to target vessel identification issues or graft occlusion.
- Four patients required graft revision for complications such as kinks, injury, or hemorrhage.
- 30 out of 31 followed patients reported no cardiac events, with one requiring percutaneous transluminal coronary angioplasty (PTCA).
Conclusions:
- MIDCAB surgery demonstrates a favorable safety profile.
- The procedure is effective in treating coronary artery disease.
- The use of a specialized device aids in successful coronary anastomosis during MIDCAB.
Abstract:
From January 1996 to May 1997, minimally invasive direct coronary artery bypass (MIDCAB) through a small anterior thoracotomy without cardiopulmonary bypass was completed in 31 of 32 patients (Male: Female=1.9:1, mean age=64.6 years, 11 (34.4%)>70 years). Twenty, five, and seven patients had one, two, and three vessel disease respectively. Twelve patients presented with unstable angina, seven had prior myocardial infarction, one had a pre-operative intra-aortic balloon pump, and four had prior coronary artery bypass grafting (CABG). Eight were diabetic, five had chronic obstructive pulmonary disease, and one was morbidly obese. Our newly developed coronary artery immobilizing and occluding device facilitated the coronary anastomosis. There were no post-procedure deaths, no peri-operative myocardial infarctions, and no strokes. One patient required intra-operative conversion to conventional CABG for an intramyocardial target vessel. Two patients had conversion after post-operative angiogram demonstrated incorrect target identification and early graft occlusion. Four patients had limited access graft revision (two kinks, one graft injury, and one haemorrhage). Thirty-one of the 32 patients were followed from 0.5 to 16 months and 30 reported no post-operative cardiac events (one required PTCA to another vessel). We conclude that MIDCAB is safe and effective.