Anatomical studies concerning technical feasibility of minimally invasive axillocoronary bypass grafting

Minimally invasive multiple vessel revascularization has been accomplished using all arterial graft concepts and aortocoronary vein grafts. The aim of the present study was to determine the technical feasibility of minimally invasive axillary artery to coronary artery vein grafting in the human cadaver.

In seven human cadavers the axillary artery was approached bilaterally via a small incision above the anterior axillary fold. The left anterior descending coronary artery system and the right coronary artery system were exposed via a left anterior minithoracotomy and a subxiphoid incision respectively. Saphenous vein grafts were anastomosed end to side to the axillary artery and brought to the target vessels following a transpleural route. The vein grafts were then sutured to the left anterior descending artery and to the posterior descending artery through the mini-incisions.

Axillocoronary bypass grafting to the left anterior descending artery was performed successfully in seven cases, axillocoronary bypass grafting to the posterior descending artery was accomplished in six cases. The mean length of the mini-incisions was as follows: left axillary artery exposure 5.1+/-1.5 cm, right axillary artery exposure 5.5+/-2.0 cm, left anterior minithoracotomy 10.8+/-1.9 cm, subxiphoid incision 9.4+/-1.9 cm. The mean length of saphenous vein required for the left axillary artery to left anterior descending artery bypass was 18.9+/-2.8 cm, the mean length of vein required for the right axillary artery to posterior descending artery bypass was 26.0+/-2.6 cm. This was significantly longer than the aortocoronary route (ascending aorta to left anterior descending artery 12.5+/-2.2 cm P = 0.0001, ascending aorta to posterior descending artery 18.3+/-2.9 cm P < 0.0001).

From this study we conclude that minimally invasive axillocoronary venous bypass grafting to the left anterior descending artery system and to the distal right coronary artery system is technically feasible in the human cadaver.