Minimaal invasieve coronaire bypasschirurgie; de eerste klinische ervaringen in het Academisch Ziekenhuis Groningen

To evaluate the feasibility of minimally invasive coronary artery bypass grafting (mini-CABG) and the clinical results of the first 70 consecutive patients who underwent mini-CABG.

Design

Retrospective.

Setting

Thorax centre of Groningen University Hospital, the Netherlands.

Methods

Seventy patients with angina pectoris and electrocardiographically objectivated ischaemia, due to proximal stenosis of the left anterior descending coronary artery (LAD) or of the right coronary artery (RCA) were included in the study. Inclusion criteria were characteristics of the stenosis implying increased risk for morbidity and mortality at PTCA and a second coronary operation in patients who had a stenosed vein graft to the LAD. Through a small anterolateral thoracotomy (8-10 cm) in the 4th or 5th intercostal space the left internal mammary artery (LIMA) was harvested. The LIMA-to-LAD anastomosis was performed on the beating heart without cardiopulmonary bypass, by means of devices which provided temporary stabilization and occlusion of the LAD. Data of the period of hospital stay were gathered by using a standard form and on the period thereafter by telephone interviews with the patients, their general practitioners or cardiologists.

Results

The in-hospital mortality was 2. In 4 patients perioperative myocardial infarction occurred. Conversion to conventional CABG was needed in 3 patients, and a temporary postoperative intra-aortic balloon pump in 1. Rethoracotomy for bleeding was done in 1 patient, who received blood transfusion. In the other patients mean postoperative bleeding was 310 ml (SD: 180). Complications were respiratory infection (n = 2) and atrial fibrillation (n = 10). The mean operation time was 95 min (SD: 26). The mean hospital stay was 4.5 days (SD: 1.9).

Conclusion

The mini-CABG is a feasible treatment for patients with high-risk stenosis of the LAD or RCA or with a diseased vein graft to the LAD, with an acceptable mortality and morbidity and a short hospital stay.