Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Clinical Experiences of MIDCAB - Developmental Stage and Early Short-term Results -

최소침습적 관상동맥우회술의 발전단계와 경험에 대한 고찰

  • Published : 1999.11.01
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Abstract

Background: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). Result: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. Conclusion: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.

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