Minimally invasive direct coronary bypass versus cardiopulmonary technique: angiographic comparison

Background. Studies comparing minimally invasive direct coronary artery bypass grafting (MIDCABG) with techniques using cardiopulmonary bypass (CPB) are needed. Methods. Sixteen patients underwent single-vessel left internal thoracic artery–left anterior descending (LITA-LAD) MIDCABG through a left anterior thoracotomy, and 10 underwent multivessel bypass grafting that included a LITA-LAD, using CPB. Intraoperative completion angiography was performed on all LITA-LAD bypasses, and graded. One point each was given for: anastomotic patency, pedicle patency, intercostal obliteration, proper placement into the correct native coronary artery, and Thrombosis In Myocardial Ischemia grade III flow. Results. There were no intraoperative deaths or morbidities. LITA takedown averaged 49 ± 18.6 minutes for MIDCABG and 16 ± 2.0 minutes for CPB CABG (p< 0.05). LITA length did not differ between groups (15.3 ± 1.2 cm for MIDCABG, 14.3 ± 1.08 cm for CPB CABG). Ischemic arrest time was significantly less for the CPB group (13.3 ± 8.3 minutes versus 24.5 ± 9.6 minutes; p< 0.05). Average grade for MIDCABG LITA-LAD was 4.06 ± 0.98 points versus 4.77 ± 0.98 points for CPB LITA-LAD bypass (p = not significant). Conclusions. Intraoperative completion angiography is feasible and, when combined with a grading system, may facilitate the comparison of MIDCABG with standard techniques.