Angiographic results after minimally invasive coronary bypass grafting using the minimally invasive direct coronary bypass grafting (MIDCAB) approach1

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Abstract
Objective: The aim of the study was to evaluate the earlyand mid-term angiographic results after minimally invasive coronarybypass grafting using an 'off-pump' technique via a lateralminithoracotomy. Methods: In 221 out of 271 patients (81.5%)who underwent minimally invasive direct coronary bypass grafting(MIDCAB) the quality of the internal thoracic artery (ITA)-graft andthe anastomosis was evaluated by conventional coronary angiographybetween the 2nd and 6th postoperative day (POD). A subgroup of 130patients (47.9%) of the initial cohort were repeatedly controlled byangiography 6 months later. Results: The early postoperativelypatency rate of the grafts was (96.8%). Moderate anastomotic stenosisbetween 50 and 75% was found in 13/221 (5.8%) patients, whereas severestenosis of more than 75% was seen in 10/221 (4.5%) and occlusion ofthe graft in 3/221 (1.3%) patients. A stress-ECG was performed inpatients with a severe stenosis to provoke ST-segment changes orclinical findings of myocardial ischemia. A positive stress test wasfound in 4/221 patients (1,8%). Early re-intervention was required in7/221 (3.1%) patients. After 6 months, angiographic follow-up revealeda patency rate of (95.4%). Of 130 patients 5 (3.8%) presented withmoderate anastomotic stenosis, whereas 3/130 (2.0%) patients showed asevere stenosis with one patient (0.7%) having myocardial ischemiaduring stress test. Occlusion of the graft was seen in 3/130 patients(2.3%). During follow-up, 4/130 (3.0%) patients underwentre-intervention. A comparison between early postoperative and 6-month sangiogram revealed a decrease or a disappearance of the severity ofthe stenosis in 4/15 patients (26.6%). Conclusion: Sincestenosis of the anastomosis may occur after minimally invasive,beating heart coronary bypass grafting, postoperative angiographyshould be performed to provide quality control and to guideappropriate further treatment. The latter is necessary if the stenosisis accompanied by reduced run-off and evidence of myocardial ischemiaduring stress test. An improvement of early stenosis at theanastomosis may be expected in more than 25%.