Minimally invasive direct coronary artery bypass grafting: a systematic review.
OBJECTIVE
Recently minimally invasive direct coronary artery bypass grafting (MIDCAB) has become an interesting alternative to conventional coronary artery bypass grafting, especially in patients with a high-grade left anterior descending coronary artery (LAD) stenosis unsuitable for balloon angioplasty. Although MIDCAB offers several advantages such as the avoidance of sternotomy and cardiopulmonary bypass, concerns have been raised about the technical accuracy of the anastomoses that can be performed on a beating heart. Therefore, clinical and angiographic outcomes after MIDCAB are the subject of current controversy.


METHODS
A literature search for all published outcome studies of MIDCAB grafting was performed for the period from January 1995 through April 2003. Sixteen articles were enrolled in this review. The data presented in the studies was analysed with regard to clinical outcome and angiographic results.


RESULTS
Early mortality ranged from 0% to 4.9% and late mortality (>30 days after MIDCAB) ranged from 0.3% to 12.6%. Infarct rates (non-fatal myocardial infarction) ranged between 0% and 3.1%. Intra- and postoperative complications (wound infections, reoperation for management of bleeding, arrhythmias, stroke, etc.) occurred in 1.6-40%. The conversion rate to sternotomy/cardiopulmonary bypass ranged between 0% and 6.2%. Reinterventions due to graft failure were necessary in up to 8.9% of patients (surgical revision or percutaneous transluminal coronary angioplasty, PTCA). Short-term and mid-term angiographic outcomes are given in Table I.


CONCLUSIONS
Clinical outcomes and immediate graft patency after MIDCAB are acceptable. However, long-term follow-up results and further randomized prospective clinical trials comparing this new technique with standard revascularization procedures are needed.
Kettering
K
K
Department of Cardiology, University of Tübingen, Tübingen, Germany. Klaus.Kettering@t-online.de
Dapunt
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D000368:Aged; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality; D012059:Rejection, Psychology; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D019737:Transplants; D016896:Treatment Outcome