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Ann Thorac Surg 2007;83:979-985
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Long-Term Results of the Endoscopic Atraumatic Coronary Artery Bypass

Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia

Accepted for publication October 13, 2006.

^_* Address correspondence to Dr Vassiliades, The Emory Clinic, Building A, 1365A Clifton Rd, NE, Suite 2100, Atlanta, GA 30322 (Email: thomas.vassiliades{at}emoryhealthcare.org).

Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

Background: This retrospective study was undertaken to determine the long-term angiographic patency and clinical outcomes of the endoscopic atraumatic coronary artery bypass (endoACAB) procedure.

Methods: Between November 1997 and March 2005, 607 consecutive patients underwent an endoACAB consisting of (1) unilateral or bilateral manual, thoracoscopic internal mammary artery (IMA) harvesting, (2) creation of a needle-directed access port in the thoracic soft tissue (non-rib-spreading), (3) cardiac positioning and stabilization using port-based instrumentation, and (4) off-pump, direct-vision, hand-sewn anastomoses to the left anterior descending (LAD), diagonal, obtuse marginal, or main right coronary arteries, or a combination. Mean follow-up time was 18.0 ± 16.0 months (range, 2.0 to 85.7 months).

Results: The IMA was used to graft the LAD in all cases. A total of 721 anastomoses were constructed using 636 conduits. Thirty-day mortality was 1.0% (6/607). A total of 379 (62.4%) had coronary angiography after operation at a mean of 18.4 ± 17.0 months. The overall patency for the LIMA to LAD was FitzGibbon A, 95.2% (324/340), and FitzGibbon A and B, 98.5% (335/340). At 5 years, event-free survival was 92% ± 2.4%.

Conclusions: The clinical outcome and angiographic patency of grafting the LAD with the LIMA off pump through a non-rib-spreading incision compares favorably with the reported data of arrested heart grafting through a median sternotomy. The endoACAB offers an excellent alternative for patients with LAD disease as a stand-alone procedure, a multivessel grafting procedure in selected patients, or as part of a hybrid procedure in conjunction with a percutaneous intervention.

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