Totally minimally invasive cardiac surgery for coronary artery disease

Objective: We report our experience using minimally invasive techniques both to perform coronary artery bypass and harvesting of saphenous vein grafts in 25 patients with left main or triple vessels disease. Methods: From March 1997 to June 1997, 25 patients received elective coronary artery bypass grafting using minimally invasive surgical techniques for left main or triple vessels disease. Saphenous vein grafts were harvested using minimally invasive techniques under direct vision. The coronary artery bypass grafting was performed through a limited left anterior parasternal minithoracotomy under femoro-femoral or aorto-atrial cardiopulmonary bypass. The myocardium was protected by antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. Results: Three to four distal anastomoses were performed with the saphenous vein graft and the left internal thoracic arterial graft. The aortic cross-clamp time was 60135 min. The duration of cardiopulmonary bypass was 89-172 min. The postoperative course was uneventful for all patients. All patients were found to be in New York Heart Association functional class I or II on follow-up from 3-7 months after surgery. Conclusions: Minimally invasive coronary artery surgery is technically feasible and can be performed in left main or triple vessel disease safely and effectively for complete revascularization.