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J Thorac Cardiovasc Surg 1998;115:785-790
© 1998 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Systematic clinical and angiographic follow-up of patients undergoing minimally invasive coronary artery bypass

From the Department of Cardiac Surgery, Catholic University, Rome, Italy,^a and the Department of Cardiology, "Calai" Hospital, Gualdo Tadino, Italy.^b

Received for publication July 16, 1997. Revisions requested August 29, 1997; revisions received Oct. 27, 1997. Accepted for publication Oct. 30, 1997. Address for reprints: Gianfederico Possati, MD, Divisione di Cardiochirurgia, Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy.

Abstract

Objective: We herein analyze the results of the systematic clinical and angiographic control performed in a series of 77 consecutive patients undergoing minimally invasive coronary artery bypass.
Methods and Results: From January 1995 to June 1997, 77 patients underwent minimally invasive coronary artery bypass at our institution. There was one inhospital death, one noncardiac late death, and five patients had to be reoperated for graft malfunction. A total of 76 patients underwent postoperative angiographic follow-up. In 66 cases (86.8%) the thoracic artery graft, the target vessel, and the anastomosis were patent and functioning normally. In one case the graft was occluded. In the remaining nine cases the thoracic artery graft was patent but with major anomalies of either the anastomosis, the target vessel, or the course of the thoracic artery. Patients operated using especially designed instruments had angiographic results clearly superior to those of patients operated using conventional instrumentation (perfect patency rate 100% vs 81.8%). At a mean follow-up of 18 months, 98.5% of the surviving patients are asymptomatic with negative myocardial scintigraphy.
Conclusions: The perfect patency rate of minimally invasive revascularization performed without the use of dedicated instruments is unacceptably low. The use of specific devices is likely to result in a substantial improvement in the angiographic results.

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