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Minimally invasive coronary artery bypass grafting using the inferior J-shaped ministernotomy in high-risk patients

^a Department of Cardiovascular Surgery, Villa Maria Cecilia Hospital, V. Corriera 1, Cotignola, Lugo (RA), Italy
^b Department of Radiology, Villa Maria Cecilia Hospital, V. Corriera 1, Cotignola, Lugo (RA), Italy
^c Department of Anesthesiology, Villa Maria Cecilia Hospital, V. Corriera 1, Cotignola, Lugo (RA), Italy

*Corresponding author. V. Battuti Verdi n.1 Forlì. (FC), Italy. Tel.: +39 335 6223366.

E-mail address: dellamore76{at}libero.it (A. Dell'Amore).

In the last years the population of patients referred for coronary surgery has changed toward a high-risk profile. In selected cases minimally invasive approach could be a good option to reduce mortality and morbidity. Between September 2005 and September 2007, twenty-one consecutive patients underwent minimally invasive bypass surgery using the J-shaped inferior mini-sternotomy approach. All patients had a EuroSCORE higher than 6. The operative mortality was 0%. Conversion to on-pump surgery was not necessary. The mean operation time was 89±18 min, the mean ventilation time was 2.4±2.2 h, the mean intensive care unit stay was 47.2±36.5 h. In four patients a hybrid approach to achieve a complete revascularization was used. After six months from the operation the graft patency was evaluated with the 64-slice computed tomography. In high-risk coronary patients the use of the minimally invasive technique appeared a good option to achieve low morbidity and mortality. Through a mini-sternotomy approach, single- or double-vessel revascularization can be performed safely off-pump even in high-risk patients without compromising the accuracy of the anastomosis. Nevertheless, a further investigation is required to evaluate the long-term results in a larger cohort of patients.

Key Words: Minimally invasive coronary bypass surgery; Coronary disease; High thoracic epidural anesthesia; Ministernotomy; Atherosclerosis; Hybrid revascularization; Cardiac surgery

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