Abstract
Background: Coronary bypass surgery can be performed less invasively by avoiding cardiopulmonary
bypass (CPB). We present our early 'off pump' coronary bypass surgery experience in
combination with a minithoracotomy or sternotomy. Methods: Between 11/1996 and 12/1997 312 patients were included in a prospective study, 223
(Group A) underwent an antero-lateral minithoracotomy (MIDCAB) and 89 (Croup B) had
a full sternotomy (OPCAB). ITA harvesting and anastomosis was performed under direct
Vision in all cases. Different devices for local mechanical immobilization were used
to perform the anastomosis. Results: In 212 patients of group A revascularization was by a single ITA graft and in 11
patients by a double graft using the radial artery as a T graft. Conversion to sternotomy
and cardiopulmonary bypass was necessary in 12 (5.3%) patients. Intraoperative myocardial
infarction was observed in 5 patients (2.2%). Early-postoperative reoperation due
to graft failure was necessary in 5 patients (2.2%). Mortality was 0.4% (one patient).
The early postoperative graft patency rate was 97.1 % as confirmed by angiography.
In group B, 25 patients had Single graft and 64 patients multiple graft revascularization.
Intraoperative conversion to CPB was necessary in 10 patients (11.2%). Intraoperative
myocardial infarction occurred in 1 patient (1.1 %), postoperative low Output syndrome
in 2 patients (2.2%). Early postoperative reoperation due to graft failure was necessary
in 1 patient (1.1 %). Mortality was 1.1 %. Angiographic control of 48 patients after
6 months confirmed a patency rate of 92.6%. Conclusion: Coronary bypass surgery without using cardiopulmonary bypass is safe to achieve good
early and mid-term results. MIDCAB is a minimally invasive technique. Experienced
surgeons should be ready to compete with PTCA techniques.
Key words
CABG - Off pump heart surgery - Minithoracotomy - Sternotomy
