Less-invasive coronary artery bypass grafting: different techniques and approaches.
OBJECTIVE
The aim of this study was to compare four different techniques for less-invasive coronary artery bypass surgery with and without cardiopulmonary bypass (CPB) in terms of feasibility as well as in terms of the intra- and postoperative course.


METHODS
One hundred and fourteen patients were divided into four groups, according to the surgical technique. Group I: minithoracotomy, internal thoracic artery (ITA) harvesting and anastomosis under direct vision using cardiopulmonary bypass (CPB) on the fibrillating heart (n = 31). Group II: sternotomy and beating heart without CPB (n = 13). Group III: MIDCAB with CPB and cardioplegic cardiac arrest using endo-aortic balloon-occlusion, Port Access system (n = 9). Group IV: MIDCAB on the beating heart without CPB (n = 61). In total, 104 single and ten double graft procedures were performed using the radial artery T-graft technique in seven cases (groups III and IV).


RESULTS
Harvesting of the ITA graft took 41+/-16.2 min in group I and could be reduced to 31+/-8.3 min in group IV by the use of a specially-designed retractor. Complications were: death (n = 1, group I), myocardial infarction, (n = 1, group I), early occlusion of the graft (n = 1, group IV), early stenosis of the anastomosis (n = 2, groups I and IV), late stenosis of the anastomosis (n = 1, group IV), thrombosis of the femoral vein (n = 1, group III). Postoperative ventilation, ICU and hospital stay were similar among groups.


CONCLUSIONS
Based on our results, the following strategy has been developed: MIDCAB without CPB is the preferred technique for one-vessel graft procedures to the left anterior descendens (LAD) or RCA. The Port Access system (with CPB) is reserved as a second option for young patients requiring multiple-vessel grafting to the left coronary circulation (LAD/CX) and as a backup to avoid conversion. Sternotomy and an off-pump technique is used for single-vessel or multiple-vessel graft procedures in selected patients (emergency procedure, acute myocardial infarction, in the very obese).
Diegeler
A
A
Clinic of Cardiac Surgery, University of Leipzig, Heartcenter, Germany.
Falk
V
V
Krähling
K
K
Matin
M
M
Walther
T
T
Autschbach
R
R
Battelini
R
R
Mohr
F W
FW
D000465:Algorithms; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D003663:Decision Trees; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods; D013997:Time Factors