Purpose: In order to associate the major benefits of the coronary artery bypass graft (CABG), with a less aggressive procedure, minimally invasive coronary artery bypass graft (MICABG) has begun to be utilized. The aim of this work is to report our initial experience with this technical approach, using video assisted thoracic surgery (VATS) to facilitate the operation. Methods: Seventy three patients, 51 males, ranging ages from 37 to 83, and with an isolated lesion in the anterior descending artery were operated upon. Left anterior minithoracotomy, of 8-10 cm was performed at the fourth intercostal space. Through this incision the optical device for VATS as well as the surgical instruments were placed in order to provide the complete left internal mammary artery (LIMA) dissection. Bypass circulation was not used and cardiac rate decreased with the use of intravenous betablockers. For LIMA - anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was intravenously administered, besides the restrained device in the 15 last cases. Results: The 73 patients presented satisfactory postoperative progress, being released from hospital between 2 and 13 days after their operation, with a mean of 4 days. Cinecoronary angiography, which was carried out in 48 (65,7%) patients during the postoperative period, before discharge, showed occlusion of anastomosis in 2(4,2%) patients, and occlusion after anastomosis in 1 (2,1%) patient. During the follow-up, there was one death due to pneumonia and another due to thromboembolysm. The other patients remained asymptomatic during a mean period of one year. Conclusions: Surgery with MICABG is possible with better esthetic effect, lower cost and faster recovery than the conventional one in a group of patients. The use of VATS through the thoracotomy itself and restrained device are good methods in this surgical approach.
Surgery; Thoracoscopy
