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J Thorac Cardiovasc Surg 1998;115:148-151
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

The "H" graft: An alternative approach for performing minimally invasive direct coronary artery bypass

From the Division of Cardiothoracic Surgery, Department of Surgery,Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass.

Received for publication June 3, 1997. Accepted for publication August 29, 1997. Revisions requested July 30, 1997; revisions received August 27,1997. Address for reprints: William E. Cohn, MD, Beth Israel DeaconessMedical Center, 330 Brookline Ave., Dana 905, Boston, MA 02215.

Objectives: Minimallyinvasive direct coronary artery bypass permits arterial revascularizationwithout cardiopulmonary bypass, potentially decreasing associated morbidity.The procedure is, however, technically challenging and associated with significantpostoperative pain resulting from retraction through the small incision.
Methods and patient selection:> From December 1996 to April 1997, eight patients underwent grafting of theleft anterior descending coronary artery by use of a short segment of rightinferior epigastric artery attached proximally to the side of an in situ leftinternal thoracic artery. We have termed this procedure the "H"graft MIDCAB.
Results: No patients required intraoperative conversion to conventional bypass.No postoperative deaths or myocardial infarctions occurred. Six patients withnormal renal function underwent postoperative angiography that demonstratedgraft patency with rapid filling of the left anterior descending coronaryin each case. Postoperatively clinical signs of acute ischemia were resolvedor a normal exercise tolerance test was obtained in all patients. The medianpostoperative length of stay was 3 days. Rib spreading and chest wall retractionwere not required in any procedure.
Conclusions: The "H" graft procedure is anattractive alternative to standard minimally invasive bypass because of greatertechnical simplicity, the avoidance of internal thoracic artery harvest, andexcellent visualization with no chest wall retraction.

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