Objective : Minimally invasive direct coronary artery bypass (MIDCAB) through a left minithoracotomy presents potential advantages. Routinely used to treat isolated lesion of the left anterior descending artery (LAD), we expand the benefits of MIDCAB concept to more than a single vessel disease. We describe our technical evolution from rib resection to soft tissue retraction and present the mid term follow-up results.
Methods : Between April 1997 and June 2003, 68 patients (50 male, 18 female, mean age 65) underwent a MIDCAB procedure. Sixty-height (100%) had an endoscopic left internal mammary artery (LIMA) harvesting followed by a bypass to the LAD. Twenty-nine (42,6%) had 2 anastomoses: 17 on LAD + diagonal branch (D); 8 on LAD + right coronary artery (RC) and 4 on LAD + circumflex (CX). Two patients had 3 anastomoses LAD + D + RC. The clinical follow-up (100%) was completed for a mean period of 27 months. Patients underwent angiography or ultrasonography or fast scan computed tomography.
Results : There was one hospital death of intestinal ischemia and two same day reoperations for LITA stenosis in regard to a diagonal branch anastomosis and for postoperative thrombosis of a right coronary artery. At 1 year follow-up, there was one sudden death at three months and one post operative related cardiac event which needed a percutaneous transluminal coronary angioplasty (PTCA) for a 95% stenosis on a LIMA at 4 months.
Conclusions : MIDCAB procedure appears to be a safe and effective procedure for double-vessel CAD. This method allows complete revascularization with minimization of surgical trauma, but long term evaluation is mandatory.