Totally endoscopic myocardial revascularization: an experimental study.

BACKGROUND: The purpose of this study was to examine the feasibility of performing totally endoscopic myocardial revascularization through the abdominal cavity. METHODS AND RESULTS: The right gastroepiploic artery was harvested endoscopically through three troacars in 46 human cadavers. Then, a 5-cm hole was made in the diaphragm to expose the right coronary artery. With the help of two vacuum pods, we fixed a site of the right coronary artery and made a right gastroepiploic artery-right coronary artery anastomosis. In 20 cases, continuous Prolene suture was used, and in 26 experiments, we applied a sutureless technique. Twenty-three anastomosis were patent. CONCLUSIONS: Despite the low patency rate, the transabdominal approach of totally endoscopic bypass grafting is promising and demands further investigation.

Multivessel minimally invasive coronary surgery with endoscopic support.

BACKGROUND: Interest in minimally invasive coronary artery bypass (MICAB) grafting and the MICAB experience have been increasing. The purpose of this study was to develop the multivessel minimally invasive coronary revascularization technique and to estimate the effectiveness of the endoscopic support in this operation. METHODS: From January 1998 through April 1999, 190 patients (ages 38 to 72 years) underwent coronary revascularization without cardiopulmonary bypass. Among them, 69 patients (55 males, 14 females) underwent minimally invasive coronary revascularization, from 1 to 3 vessels, through minithoracotomy and ministernotomy with endoscopically dissected internal mammary artery, gastroepiploic artery, and composite grafts. Preoperative risk factors included unstable angina (n = 15), reoperations (n = 8), low ejection fraction (n = 14), renal insufficiency (n = 4), chronic obstructive pulmonary disease (n = 6), cerebrovascular accident (n = 2), diffuse atherosclerosis (n = 4) and diabetes mellitus (n = 7). RESULTS: The operative mortality was 1.5% (1/69). Morbidity included wound infections (n = 1), reoperation for management of bleeding (n = 1), acute graft occlusion (n = 1), perioperative myocardial infarction (n = 1). The number of grafts placed in 69 patients was as follows: single, 54; double, 10; triple, 5. Postoperative angiography and Doppler flow assessment of the coronary anastomoses performed in 22 patients (30%) showed that 97% were patent. CONCLUSIONS: The minimally invasive direct coronary artery bypass grafting operation is safe and effective. Endoscopic support makes the use of minimally invasive technology possible in patients with multivessel coronary disease and makes this operation less traumatic.