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Ann Thorac Surg 1999;68:383-389
© 1999 The Society of Thoracic Surgeons

Original Articles

Results of graft patency by immediate angiography in minimally invasive coronary artery surgery

Michael J. Mack, MDa, James A. Magovern, MDa,b, Tea A. Acuff, MDa,b, Rodney J. Landreneau, MDa,b, Denise M. Tennison, MSNa,b, Erin J. Tinnerman, PA-Ca,b, John A. Osborne, MD, PhDa,b

a Medical City Dallas Hospital, Dallas, Texas, USA
b Allegheny University Hospital, Medical College Pennsylvania, Pittsburgh, Pennsylvania, USA

Address reprint requests to Dr Mack, 7777 Forest Lane, C-742 Dallas, TX 75230
e-mail: mmack{at}crsti.org

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

Background. Although minimally invasive direct coronary artery bypass (MIDCAB) is being employed for revascularization of the left anterior descending coronary artery (LAD) with the left internal mammary artery (LIMA), little objective data exist regarding graft patency. Because the procedure is performed on a beating heart through a limited access approach, concerns have been raised regarding the ability to perform as accurate an anastomosis compared with conventional coronary artery bypass (CAB).

Methods. A prospective study of consecutive patients undergoing MIDCAB LIMA to LAD was undertaken. All procedures were performed through a limited anterior thoracotomy incision with a stabilization device. Selective angiography of the LIMA graft was performed intraoperatively or in the immediate postoperative period.

Results. One hundred and three patients underwent the MICAB procedure. Angiographic evaluation of the anastomosis was obtained in 100 patients (97%). Angiographic graft patency was 99%, with perfect graft patency (no stenosis greater than 50%) being 91%. Three grafts were revised in the operating room. One patient underwent reoperation and 3 more underwent percutaneous transluminal coronary angioplasty. There were two noncardiac mortalities (1.9%), both with patent grafts.

Conclusions. Immediate graft patency after MIDCAB is acceptable, and comparable with conventional CAB data, although meaningful comparison is difficult. The significance of early angiographic findings and the role for early angiography remain to be defined.




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