Video-assisted minimally invasive coronary operations without cardiopulmonary bypass: A multicenter study

Objective: The need to avoid the risks associated with cardiopulmonary bypass has led to the interest in coronary operations without cardiopulmonary bypass, Patients and methods: From April 1994 to September 1995, 44 patients (mean age 63.3 +/- 10.0 years, range 43 to 83 years) were selected for video-assisted coronary artery bypass grafting without cardiopulmonary bypass through a small anterior thoracotomy, Mean preoperative ejection fraction was 50.7% +/- 13.4% (range 20% to 65%). Four patients had left ventricular dysfunction (ejection fraction below 35%), Thirty patients had stable angina (26 with class 3 angina) and 14 had unstable angina, One had recurrent angina (redo), In all cases a small (3.5 to 11 cm) anterior thoracotomy (43 left and one right) was performed and the harvesting of the left internal thoracic artery was video-assisted by thoracoscopy, Results: The left internal thoracic artery was used in 43 cases to graft the left anterior descending coronary artery; the right thoracic mammary was used in one case to graft the right coronary artery; the radial artery was used in one case to perform a T-graft to the first diagonal and first marginal branches, We recorded one death (2.3%) and one case of postoperative low cardiac output syndrome (2.3%), Perioperative myocardial infarction occurred in two cases (4.5%), We did not record noncardiac complications (cerebrovascular complications, kidney failure, prolonged ventilatory support, or wound complications), Supraventricular and ventricular arrhythmias were never detected, Conclusion: According to our experience, video-assisted coronary bypass through a small anterior thoracotomy is a new promising technique that can be considered an alternative in most cases to angioplasty and complementary to conventional coronary operations.