Minimally invasive cardiac surgery for the treatment of coronary artery multi-vessel disease

Objective: In order to avoid sternotomy-related complication after cardiac surgery minimally invasive cardiac surgery has been developed successfully for the treatment of coronary artery disease, however, those techniques were still limited to the treatment of single-vessel disease. Therefore a new surgical technique for the treatment of multi-vessel disease has been developed. Methods: From November 1996 to May 1997 61 patients (age 39–78 years) with coronary artery disease were treated with this new technique. This technique included a small (6–9 cm) left lateral chest incision via the 3rd intercostal space. The left internal thoracic mammary artery (LIMA) was harvested through the chest incision and access to the central portion of the heart including the ascending aorta was obtained. During LIMA harvesting saphenous vein segments were harvested. Cardiopulmonary bypass was instituted through femoral vein cannulation and cannulation of the ascending aorta in most cases. After external aortic cross clamping cold antegrade cardioplegia was applied. In all patients except one the LIMA was used for the left anterior descending artery (LAD). In addition vein grafts were used for revascularisation of the other coronary arteries. Results: There were no intraoperative complications and all patients survived the procedure. All patients could be weaned from CPB and the postoperative course was uneventful in most patients. Wound complication occurred in two patients. The median hospital stay was 6 days (median±SEM). Conclusions: This new technique combines minimally invasive surgical conditions with the safety standards of routine cardiac surgery. With this approach even extensive coronary artery disease can be treated.