Objective: Early reports showed a high incidence of postoperative morbidity and mortality after coronary endarterectomy, and its value is still controversial. With technical improvement the role of coronary endarterectomy has been reviewed. In this study we evaluate our results of coronary endarterectomy, and show our strategy for patients with diffuse coronary artery disease. Method: We retrospectively reviewed 278 patients who underwent coronary artery bypass grafting, between January 2000 and December 2001, separated in two groups. The endarterectomy group-32 patients (11.5%) who underwent coronary endarterectomy and the control group of patients characteristics similar to the first group. Results: The mean follow-up time was 9.9 months. Both groups only demonstrated a statistical difference in the number of previous myocardial infarctions. The coronary endarterectomy was performed on 38 vessels, 78.75% in the left coronary system, and 21.05% in the right system. In the postoperative follow-up no significant differences were detected, but in the coronary endarterectomy group the incidence of intra-aortic balloon pump insertion was higher. Conclusions: We demonstrated that coronary endarterectomy should be used to achieve complete revascularization in patients with diffuse coronary disease, and the results are similar to conventional surgical treatment. A long-term follow up is necessary to demonstrate the future performance of these vessels and grafts.

Objective: Minimally invasive heart surgeries are approaches used to reduce trauma, to give better cosmetic results and to reduce hospital costs with the same safety as conventional surgery. This study was designed to compare the operative results from patients who underwent minimally invasive aortic valve replacement with those who were submitted to the standard procedure.Method: The operative and immediate postoperative results of 12 consecutive patients who received minimally invasive isolated aortic valve replacements from June 2002 to February 2003 were compared to 12 patients who underwent to traditional approach in the same institution. The minimally invasive access used was superior median hemisternotomy where cardiopulmonary bypass was established through ascending aorta and right atrium cannulation, similar to the traditional technique.Results: The demographics of the patients were similar in both groups. There were no significant differences between aortic clamping time, total bypass time and operating time. The skin incision length was statistically shorter in the minimally invasive group. In the postoperative course, the mechanical ventilation time and the total hospital stay were shorter, but not statistically significant, in the minimally invasive group. The morbidity was the same in two groups.Conclusions: This surgical approach provides adequate exposure of the cardiac structures necessary to perform a safe valve replacement. With the same instruments used in the traditional surgery we can offer the benefits of a less invasive access with the same efficiency as in the conventional approach without adding any risks to our patients. Descriptors