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[Minimally invasive direct coronary artery bypass grafting (MIDCAB) for right and circumflex coronary artery systems]
G Watanabe1, T Misaki, K Kotoh
1Department of Surgery, Toyama Medical and Pharmaceutical University, Japan.
Insights
Multi-vessel minimally invasive direct coronary artery bypass (MIDCAB) using in-situ arterial grafts is a safe and effective option for patients with complex coronary artery disease. This technique demonstrates excellent graft patency and no operative mortality.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Coronary Artery Disease Management
Context:
- Single-vessel coronary artery bypass grafting using the left internal thoracic artery (LITA) to the left anterior descending coronary artery (LAD) via mini-thoracotomy yields excellent outcomes.
- However, this approach is not suitable for patients with double or triple vessel disease.
Purpose:
- To evaluate the feasibility and efficacy of multi-vessel minimally invasive direct coronary artery bypass (MIDCAB) for treating complex coronary artery disease.
- To assess the outcomes of using in-situ arterial grafts for multi-vessel MIDCAB procedures.
Summary:
- A study involving 17 patients undergoing multi-vessel MIDCAB procedures between August 1996 and December 1997.
- Procedures involved thoracicscopic harvesting of LITA and right internal thoracic artery (RITA), followed by harvesting of the right gastroepiploic artery (RGEA), inferior epigastric artery, and radial artery.
- Various minimally invasive incisions were employed, with most patients undergoing double MIDCAB and one patient undergoing triple MIDCAB.
Impact:
- The study demonstrated no operative deaths, with all patients alive and well at follow-up.
- Postoperative angiographic studies revealed a high graft patency rate of 30 out of 31 grafts.
- Multi-vessel MIDCAB with in-situ arterial grafts presents a viable, less invasive surgical option for managing multi-vessel coronary artery disease.
Background:
Single-vessel coronary bypass grafting of the left internal thoracic artery (LITA) to the left anterior descending coronary artery (LAD) with mini-thoracotomy has been shown to produce excellent results with almost no mortality. However this procedure cannot be used in patients with double or triple vessel disease.
Methods:
Between Aug. 96 and Dec. 97, 17 pts underwent minimally invasive direct coronary artery bypass (MIDCAB) to right (RCA) and circumflex coronary artery (CX). LITA and RITA were thoracicscopically harvested and the right gastroepiploic artery (RGEA), inferior epigastric artery, and radial artery were then harvested. A limited left thoracotomy in combination with limited anterior right thoracotomy (n = 3) or right lower parasternal incision extending to below the xiphoid process (n = 6) were made. The double MIDCAB as performed in 16 pts and triple in 1 pt.
Results:
There was no operative death. At follow up, all pts are alive and well. The postoperative angiographic studies showed 30/31 grafts were patent.
Conclusion:
The utility of multi-vessel MIDCAB for the LAD, CX and RCA with in-site arterial grafts has been demonstrated in the present study. This less invasive surgical technique may become a viable option for the management of multi-vessel coronary artery disease.