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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2002 February;43(1):11-5

language: English

Minimally invasive direct coronary artery bypass for completely obstructed left anterior descending coronary artery

Hayashi Y., Hirata N., Satoh H., Ohtake S., Sawa Y., Nishimura M., Shintani T., Matsuda H.

From the Department of Surgery Course of Interventional Medicine (E1) Osaka University Graduate School of Medicine Osaka, Japan


Background. We eval­u­at­ed the effi­ca­cy of min­i­mal­ly inva­sive ­direct cor­o­nary ­artery ­bypass (MID­CAB) ­using the ­left inter­nal tho­rac­ic ­artery (­LITA) in ­patients ­with com­plete­ly obstruct­ed ­left ante­ri­or descend­ing cor­o­nary ­artery (LAD).
Methods. Ten ­patients under­go­ing MID­CAB for LAD sten­o­sis ­were ­enrolled in ­this ­study. These ­patients ­were all men ­aged 45 to 69 ­years, and ­were divid­ed ­into two ­groups, one show­ing com­plete LAD obstruc­tion (n=5, Group A), and one ­about 90% sten­o­sis of the LAD (n=5, Group B).
Results. The inter­nal ­size of the LAD at the anas­tom­o­sis ­site was sig­nif­i­cant­ly small­er in Group A ­than in Group B, and the ­time ­required for ­graft anas­tom­o­sis in Group A was sig­nif­i­cant­ly long­er. Total oper­a­tion ­time, intu­ba­tion ­time ­after operation, per­i­op­er­a­tive bleed­ing, ­total ­blood trans­fu­sion, max CK-MB, and hos­pi­tal ­stay did not significantly dif­fer ­between the two ­groups. Postoperative cor­o­nary angio­gra­phy ­revealed ­good ­graft paten­cy in ­both ­groups, how­ev­er, one Group A ­patient had ­graft obstruc­tion.
Conclusions. The MID­CAB pro­ce­dure ­appears use­ful ­even in our ­patients ­with com­plete­ly obstruct­ed LAD, ­despite the ­long anas­tom­o­sis ­time. However, the indi­ca­tions for ­this pro­ce­dure are lim­it­ed by any per­ceived dif­fi­cul­ty in har­vest­ing the ­LITA by indi­rect ­vision or in per­form­ing the anas­tom­o­sis ­based on the ­size or qual­ity of the LAD. Intensive pre­op­er­a­tive angio­gra­phy eval­u­a­tion is essential and con­ver­sion to a ­median ­full-ster­not­o­my is nec­es­sary for cas­es in ­which we can­not con­firm the fea­sibil­ity of MID­CAB.

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