Original Articles
Results of graft patency by immediate angiography in minimally invasive coronary artery surgery

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.
https://doi.org/10.1016/S0003-4975(99)00648-7Get rights and content

Abstract

Background. Although minimally invasive direct coronary artery bypass (MIDCAB) is being employed for revascularization of the left anterior descending coronary artery (LAD) with the left internal mammary artery (LIMA), little objective data exist regarding graft patency. Because the procedure is performed on a beating heart through a limited access approach, concerns have been raised regarding the ability to perform as accurate an anastomosis compared with conventional coronary artery bypass (CAB).

Methods. A prospective study of consecutive patients undergoing MIDCAB LIMA to LAD was undertaken. All procedures were performed through a limited anterior thoracotomy incision with a stabilization device. Selective angiography of the LIMA graft was performed intraoperatively or in the immediate postoperative period.

Results. One hundred and three patients underwent the MICAB procedure. Angiographic evaluation of the anastomosis was obtained in 100 patients (97%). Angiographic graft patency was 99%, with perfect graft patency (no stenosis greater than 50%) being 91%. Three grafts were revised in the operating room. One patient underwent reoperation and 3 more underwent percutaneous transluminal coronary angioplasty. There were two noncardiac mortalities (1.9%), both with patent grafts.

Conclusions. Immediate graft patency after MIDCAB is acceptable, and comparable with conventional CAB data, although meaningful comparison is difficult. The significance of early angiographic findings and the role for early angiography remain to be defined.

Section snippets

Patients and methods

From December 1996 through December 1997, 100 of 103 consecutive patients undergoing minimally invasive LIMA to LAD procedure by a limited access approach were studied by intraoperative or immediate postoperative angiography. The patient demographics and characteristics of the study population are contained in Table 1. There were two main population cohorts. One group was young, healthy patients with single-vessel disease who usually presented with LAD re-stenosis after a previous

Results

Between December 1996 and December 1997, a total of 103 patients underwent isolated revascularization of the LAD using the LIMA by a limited access approach on a beating heart. All patients who underwent this procedure during this time period were included in this study. Patients in this time period who underwent conventional coronary artery bypass grafting, beating heart revascularization by a median sternotomy approach, or more than one bypass through a limited access incision were not

Comment

Numerous issues are raised by this study, including the role of immediate angiography in the evaluation of LIMA graft patency, the significance of abnormal angiographic findings, and the comparability of these results with existing data regarding LIMA patency in conventional coronary artery bypass grafting.

Regarding the technique of intraoperative angiography, numerous issues exist. Should it be performed by the surgeon or by a cardiologist? In our institution, when performing intraoperative

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Copyright © 1999 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.