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[Minimally invasive direct coronary artery bypass for ischemic heart disease associated with preoperative severe
T Isomura1, R Sato, N Hayashida
1Shonan Kamakura General Hospital, Kamakura, Japan.
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) offers a safe and effective surgical option for select patients with complex coronary artery disease, including those with left main lesions and comorbidities. This approach demonstrated uneventful postoperative recovery in two challenging cases.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Bypass Grafting
Background:
- Minimally invasive direct coronary artery bypass (MIDCAB) is an alternative surgical technique for coronary artery revascularization.
- Selected patients with complex coronary artery disease, including left main lesions and significant comorbidities, may benefit from MIDCAB procedures.
- Review of literature and case studies are essential for understanding the efficacy and safety of MIDCAB.
Observation:
- Two male patients, aged 69 and 80, with left main coronary artery lesions and significant comorbidities (cerebral infarction, renal dysfunction, acute myocardial infarction, chronic hemodialysis) were treated with MIDCAB.
- Patient 1 underwent standard MIDCAB using left internal thoracic artery (ITA) to left anterior descending artery (LAD) anastomosis.
- Patient 2, requiring intraaortic balloon pumping (IABP) and with a history of congestive heart failure, received a composite graft of ITA and left inferior epigastric artery (IEA) to LAD under beating heart conditions.
Findings:
- Both patients experienced uneventful postoperative courses, with early ventilator weaning (3 hours for Patient 1, IABP removal at 8 hours for Patient 2).
- MIDCAB procedures, utilizing minithoracotomy, were successfully performed in these high-risk patients.
- The use of extended grafts (composite ITA-IEA) facilitated successful revascularization in the presence of cardiac enlargement.
Implications:
- MIDCAB surgery appears to be a viable and effective strategy for selected patients with complex coronary artery disease and high-risk profiles.
- The technique demonstrates potential for minimizing postoperative complications in challenging surgical candidates.
- Further research and case series are warranted to establish the broader applicability and long-term outcomes of MIDCAB.
Abstract:
Our experiences of minimally invasive direct coronary artery bypass (MIDCAB) were reported with review of literatures. Patient #1 was a 69 years-old man with left main lesion associated with cerebral infarction and impaired renal function. Preoperative CT examination showed calcified ascending aorta. There was no significant lesions in the large right coronary artery and the circumflex was small. The patient underwent MIDCAB via minithoracotomy on the fourth intercostal space with left internal thoracic artery (ITA) to left anterior descending artery (LAD). The patient was weaned from ventilator 3 hours after the operation and his postoperative course was uneventful. Patient #2 was a 80 years-old man with acute myocardial infarction requiring intraaortic balloon pumping (IABP) due to significant stenosis in the right coronary artery and left main lesion associated with chronic hemodialysis due to renal failure. The right coronary artery was dilated by balloon angioplasty at the time of emergency coronary angiogram. However, the emergent operation was required because of the left main lesion. The circumflex was relatively small and because of severe complication, MIDCAB was selected to improve his condition. He underwent MIDCAB via minithoracotomy. The heart was enlarged because of congestive heart failure and left inferior epigastric artery was used to extend the length of the left ITA. The composite graft of ITA and IEA was anastomosed to the LAD under beating heart. The IABP was removed 8 hours after the operation and his postoperative course was uneventful. The MIDCAB for coronary artery bypass was first reported by Benetti et al in 1995 and the procedure seemed to be very effective for preventing postoperative complications in selected patients as seen in ours.