title: Minimally invasive direct coronary artery bypass for left anterior descending artery revascularization - analysis of 300 cases.
abstract: BACKGROUND
  Minimally invasive direct coronary artery bypass (MIDCAB) grafting is performed via small, left anterolateral thoracotomy. The left internal mammary artery was grafted to the left anterior descending (LAD) artery in 300 consecutive patients.
  
  
  OBJECTIVE
  In-hospital results were evaluated and compared with the conventional, off-pump coronary artery bypass graft procedure.
  
  
  METHODS
  One hundred and sixty-three (54.33%) of 300 patients underwent staged hybrid coronary revascularization, 93 (31%) were treated for a single LAD lesion, and 44 (14.67%) were treated for multi-vessel disease with reasonably incomplete revascularization. Major in-hospital cardiac adverse events and postoperative data were compared between groups.
  
  
  RESULTS
  Preoperative data were similar between groups. However, the difference in left ventricular ejection fraction (p < 0.001) was significant. No conversions to sternotomy occurred during the primary MIDCAB procedures. Shorter operation time (p < 0.001), shorter postoperative mechanical ventilation time (p < 0.001), shorter intensive care unit stay (p < 0.001), and less red blood cell transfusion (p < 0.001) were noted in the MIDCAB group. Postoperative coronary angiography conducted in the MIDCAB group within one week after the operation showed that 2 of 163 patients developed graft occlusion. These patients underwent conventional CABG and recovered well. No significant differences were observed in postoperative MI, delayed wound healing or 30-day in-hospital mortality between the two groups.
  
  
  CONCLUSIONS
  The use of a chest wall lifting system and modified stabilizer makes the MIDCAB procedure safer and easier. The MIDCAB procedure is demonstrated to be a feasible and minimally invasive alternative for patients with coronary artery disease involving LAD lesions.
authors: Third Hospital of Peking University, Beijing, China.
authors: Lufeng
authors: L
authors: Zhang
authors: Third Hospital of Peking University, Beijing, China.
authors: Zhongqi
authors: Z
authors: Cui
authors: Third Hospital of Peking University, Beijing, China.
authors: Zhiming
authors: Z
authors: Song
authors: Third Hospital of Peking University, Beijing, China.
authors: Hang
authors: H
authors: Yang
authors: Third Hospital of Peking University, Beijing, China.
authors: Yuanhao
authors: Y
authors: Fu
authors: Third Hospital of Peking University, Beijing, China.
authors: Yichen
authors: Y
authors: Gong
authors: Third Hospital of Peking University, Beijing, China.
authors: Yunpeng
authors: Y
authors: Ling
keywords: coronary artery bypass grafts surgery; minimally invasive surgery; off-pump surgery