From October 1995 until October1997, Minimally Invasive Direct Coronary Artery Bypass
(MIDCAB) surgery was the therapeutical option in 71 patients (42 males/29 females)
because of the low degree of invasiveness and the avoidance of ECC-support.
The majority of the patients (84,5%) had single vessel disease (3-vessel disease: 5 %, 2-
vessel disease: 5% and 1.5 % Left Main Disease).
Specific indications were diabetes (12 pts), previous malignancy (4 pts), calcified aortic
root/arch (1 pt), muscle-distrophy (1 pt), Jehovah’s witness (1 pt) and redo CABG (1 pt).
28,2% of the patients had previous PTCA/stent procedures.
The harvesting of the LIMA was video-assisted. Conversion to sternotomy without the use
of ECC occurred in one patient in which the video-assisted prelevation of the LIMA was
incomplete because of severe obesity.
Major postoperative events: 2 reoperations for distal IMA dissection (early experience) and
2 revisions for bleeding. 2 patients died: one 83-year-old female with 3-vessel disease and
one 77-year-old male with 2-vessel disease.
In the first 50 patients, postoperative control-angiography was carried out before discharge
from the hospital. 96% of the LIMA’s were patent (2 LIMA dissections were subsequently
repaired). In one patient, the proximal run-off in the LAD was poor.
Conclusion : The cost and the risk of endoluminal treatment of LAD may lead to a new
strategy of multiple vessel CAD treatment. The value, in the long term, of IMA to LAD and
its excellent costeffectiveness in MIDCAB may pave the way for hybrid therapy in multiple
vessel disease. MIDCAB has a great potential for a subset of patients and can fill the gap
between interventional cardiology and standard CABG.