Minimally invasive LAD revascularisation in high-risk patients with three-vessel coronary artery disease

A potential advantage of minimally invasive direct coronary artery bypass (MIDCAB) is that patients in whom conventional coronary bypass surgery is associated with increased risk because of various associated medical conditions, or those with relative contraindications to cardiopulmonary bypass, can benefit from surgical revascularisation. We reviewed our experience with adopting MIDCAB in the management of patients with three-vessel coronary artery disease over an 8 month period.

Thirteen patients (3 females, mean age 67.6 years) with severe symptomatic three vessel coronary artery disease on maximum medical treatment (angina class III or IV) received left internal mammary artery grafts to the left anterior descending coronary artery using the MIDCAB approach. Associated co-morbidity included: severe chronic renal failure (n=2), severe extensive arteriopathy (n=4), chronic obstructive airway disease (n=2), poor general condition (n=2) and severely impaired left ventricular function (n=3).

There was one early postoperative mortality and no other cardiac related morbidity. All patients were extubated within 3 h of leaving the operating room, mean ITU stay was 15 h and mean hospital stay was 5 days. Graft patency was investigated using angiography in all patients; all grafts but two were patent. In combination with medical therapy, all patients remain entirely angina free at a follow-up period between 3-11 months.

MIDCAB is an effective approach for managing high-risk patients with symptomatic three-vessel coronary artery disease. Longer follow-up is needed to further clarify patient selection and the long-term outcome of this approach.