Facing the era of minimally invasive coronary grafting: current results of conventional bypass grafting for single-vessel disease

Abstract

Background: The concepts of minimally invasive coronary artery bypass grafting have gained increasing attention and interest from cardiac surgeons. Operations through small incisions are mostly applied to patients with less extensive coronary disease, mostly single-vessel disease. The aim of this study was to identify a baseline level of conventional coronary bypass grafting for this group of patients, particularly with regard to surgical complications and immediate results.

Methods: Of 3,637 consecutive patients undergoing coronary artery bypass grafting during the period 1989 to 1995, 99 patients (2.7%) were identified to have single-vessel disease. The preoperative and hospital data of this subset of patients were analyzed.

Results: The left internal mammary artery was grafted in 96% of the patients, either as single graft to the left anterior descending artery or sequentially to the left anterior descending artery and a diagonal branch. Additional vein grafts were placed in 36 patients, and the mean number of distal anastomoses was 1.6 +/- 0.6. Mean ischemic time and cardiopulmonary bypass time were 15.3 +/- 9.6 minutes and 29.0 +/- 12.5 minutes, respectively. The patients were weaned from the ventilator 1.5 +/- 0.8 hours postoperatively, and all patients were out of bed the morning after the operation. No patients required homologous blood or plasma transfusions. The morbidity rate was low, and all patients survived.

Conclusions: For this highly selected group of patients, coronary artery bypass grafting based on median sternotomy, cardiopulmonary bypass, and cardioplegic arrest carries a very high rate of immediate success. Such data may be useful as a baseline when considering the costs and benefits of new surgical procedures.