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Ann Thorac Surg 2005;80:1336-1339
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Redo Minimally Invasive Direct Coronary Artery Bypass Grafting

Department of Cardiac Surgery, Heartcenter, University of Leipzig, Germany

Accepted for publication March 16, 2005.

^_* Address reprint requests to Dr Jacobs, Klinik für Herzchirurgie, Universität Leipzig Herzzentrum, Strümpelstrasse 39, 04289 Leipzig, Germany (Email: stjacobs{at}aol.com).

BACKGROUND: Conventional redo coronary artery bypass grafting is associated with an increased risk of mortality and morbidity as a result of manipulation of patent grafts, mediastinitis, and the presence of pericardial adhesions. Minimally invasive direct coronary artery bypass grafting may be an alternative approach in selected patients.

METHODS: From January 1997 to October 2003, 46 patients (mean age, 66 ± 7.4 years) underwent minimally invasive direct coronary artery bypass grafting using the left internal thoracic artery to the left anterior descending artery on the beating heart as a reoperation. Patients after previous cardiac operation by means of median sternotomy without use of the left internal thoracic artery presenting with a significant left anterior descending artery stenosis ("culprit lesion") were included. Predicted mortality was 13.6% (range, 2.4% to 72.8%) as calculated by the logistic Euroscore; ejection fraction was 0.531 (range, 0.14 to 0.81). Surgical results were analyzed for mortality, morbidity, duration of the procedure, hospital stay, and event-free survival.

RESULTS: Mean operating time was 103 ± 34 minutes. There were two in-hospital deaths (4.6%), one for malignant ventricular arrhythmia (Euroscore, 60.9%) and the second as a result of severe gastrointestinal bleeding (Euroscore, 29.2%). One patient (2.3%) was successfully reoperated on because of perianastomotic hematoma using the same approach after 6 days. Patients were discharged after 9.4 ± 2.6 days. There were no other serious adverse events, no stroke, and no myocardial infarction. During follow-up (37 ± 21 months, complete in 92.1%), 1 patient experienced angina and 6 patients died. The actuarial 4-year survival is 74.8% (95% confidence interval, 51% to 92%), and the actuarial 4-year event-free survival including freedom from angina, major adverse cardiac events, and reintervention is 81% (95% confidence interval, 54% to 97%).

CONCLUSIONS: Minimally invasive direct coronary artery bypass grafting can be considered as an alternative approach for redo coronary artery bypass grafting in selected patients.

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