[The clinical effect and long-term follow-up of minimally invasive direct coronary artery bypass grafting via left anterior small thoracotomy].
OBJECTIVE
To estimate the clinical effect and long-term follow-up of minimally invasive direct coronary artery bypass grafting (MIDCAB) via left anterior small thoracotomy.


METHODS
MIDCAB via left anterior small thoracotomy approach was performed in 38 cases of coronary artery disease with single or multi-vessel involvement from January 2002 to October 2006. There were 25 males and 13 females with a mean age of (63.3 +/- 11.1) years old. The left internal mammary artery (LIMA) was harvested under direct vision or with the assistance of thoracoscopy. After heparinization the pericardium was directly opened to expose the target vessels. The coronary artery bypass grafting was completed on beating heart.


RESULTS
The procedure were smoothly completed in all the 38 cases. The LIMA was anastomosed to the left anterior descending artery (LAD) or the diagonal artery in 20 cases, while two bypass grafts were performed in 8 cases (including 3 cases of sequential grafting and 5 cases of LIMA-radial artery Y-shaped grafting). Hybrid procedure was performed on 10 patients. There were no serious postoperative complications and operative deaths found. All the 38 cases except one were followed for 26 to 82 (53.2 +/- 28.5) months and no myocardial infarction or death occurred. NYHA class were I in 26 cases and II in 12 cases. There were 3 recurrence of angina, 2 patients relieved their symptoms with medication while 1 patient received stent implantation because of anastomose stenosis confirmed by coronary angiography 2 years after surgery.


CONCLUSIONS
MIDCAB via left anterior small thoracotomy has low rate of mortality and adverse cardiac events. The long-term follow-up is good.
Wang
Dong-jin
DJ
Department of Thoracic and Cardiovascular Surgery, Affiliated Drum Tower Hospital, Medical College of Nanjing University, Nanjing 210008, China.
Shao
Jun
J
Wu
Zhong
Z
Chen
Bao-jun
BJ
Cao
Bin
B
Li
Qing-guo
QG
Zhou
Qing
Q
D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome