Minimally invasive coronary revascularization in elderly patients

Internal mammary artery to left anterior descending coronary artery anastomosis can be done without extracorporeal circulation on the beating heart. This method seems to have particular advantages for elderly patients, those 70 years old or older.

From January 1, 1997, to October 31, 1997, 27 patients have been operated on with a minimally invasive approach through a left-sided minithoracotomy. Twelve patients had up to four previous percutaneous interventions with percutaneous transluminal coronary angioplasty (3) or percutaneous transluminal coronary angioplasty and stent implantation (9). The remainder showed stenosis not suitable for percutaneous transluminal coronary angioplasty or an occluded vessel. In all patients the internal mammary artery was anastomosed with the left anterior descending coronary artery, and in 2 patients additionally with the first diagonal. In 1 patient the operation had to be converted to a sternotomy because it was impossible to identify the left anterior descending coronary artery.

All patients survived the operation. There was no perioperative infarction. All patients were extubated within 4 hours. Mean stay in the intensive care unit was 20.3 hours; postoperative stay was 7.4 days. Nine patients had elective repeat angiography within 10 days postoperatively and all showed a patent graft.

We believe that minimally invasive coronary revascularization of the anterior wall can be done in elderly patients with low risk and good results.