Minimally Invasive Coronary Artery Bypass: Experience in 114 Patients

Abstract

From February 1996 to May 1998, 114 patients underwent a small (6 to 8 cm) left anterior thoracotomy for single-vessel coronary artery bypass grafting on a beating heart. There were 85 men and 29 women with a mean age of 63.1 ± 9.4 years, ranging from 36 to 84 years, and a mean preoperative ejection fraction of 53.2% ± 6.9%. The left internal mammary artery was anastomosed to the left anterior descending coronary artery under direct vision without cardiopulmonary bypass. There was no mortality. Postoperative morbidity included superficial wound infection in 3 patients. The length of the left internal thoracic artery was insufficient in two patients and the radial artery was used as an extension. Sixty-five (57%) patients underwent repeat coronary angiography (49 early, 16 late) and all grafts were patent. On intraoperative transesophageal echocardiography, no segmental wall motion was seen during local coronary occlusion. Mean operative time was 1.7 ± 0.3 hours. One hundred and three patients (90%) were discharged 2 to 4 days postoperatively. The mean follow-up was 21.7 months. Minimally invasive surgery for left anterior descending coronary artery revascularization was considered to be a simple and effective alternative to the standard operation or angioplasty in selected patients.

Efficacy of preoperative trimetazidine for preventing myocardial injury in patients undergoing off-pump coronary artery bypass grafting

“…Thirty patients undergoing first time elective off-pump CABG were randomly assigned into two groups: 15 patients received 3 times 20 mg/day trimetazidine preoperatively (trimetazidine group) and 15 patients received placebo (control group). Because of the its optimal dose and optimal time period of pretreatment, during the 3 weeks preoperatively, patients received trimetazidine orally 3 times 20 mg/day [1,5,6]. The exclusion criteria were the presence of unstable angina, acute myocardial infarction of less than one month duration, chronic renal insufficiency, ejection fraction of less than 40%, and concomitant valvular disease or skeletal muscle disease.…”

“…Although these adverse effects of cardiopulmonary bypass are mostly reversible avoiding the use of cardiopulmonary bypass either by minimally invasive CABG or off pump CABG with median sternotomy has been shown to be beneficial and to be associated with reduced myocardial injury [2][3][4][5]. Off-pump CABG is performed on beating heart without the use of cardiopulmonary bypass and global cardiac arrest.…”