BackgroundThroughaministernotomy'J'shapedapproach,leftinternalmammaryartery(LIMA)bypassgraftingtotheleftanteriordescendingartery(LAD)canbeperformedsafelyoff-pump.Toachieveacompleterevascularization,percutaneouscoronaryinterventions(PCI)withdrugelutingstentimplantationtoothercoronaryarterieswasused.Wereportedoutcomesofthetreatmentofmultivesselcoronaryarterydiseasewithminimallyinvasivecoronaryarterybypass(MICAB)andPCI.MethodsBetweenJanuary2009andDec2012,14patients(11males,3females,meanagewas64.8±10.1years.Two-vesseldiseaseaccountfor35.7%(5/14)ofthesepatients,three-vesseldisease64.2%(9/14)(Table1).Allpatientsunderwentaminimallyinvasivecoronaryarterybypassgraftingviamini-sternotomy'J'shapedapproach.SevenpatientswerefollowedbyPCI,7forobtusemarginalcircumflex,5forrightcoronaryartery(RCA).AngiographicassessmentofgraftpatencywasperformedinallpatientsduringthePCIprocedure.Theclinicalfollow-upperiodlastsfrom11-24months.ResultsThein-hospitalmortalitywas0%.Therewasneitherconversiontoafullmediansternotomynorintraoperativecomplications.Ventilationtimewas6.6±4.1h.Bloodlossranged341±78.8mL.ICUstayranged22.3±12.8h.Hospitalpostoperativestaylastedfor6.5±1.6days.PriortoPCIpatientsshowed100%patentleftinternalmammaryartery.Onepatienthadmediastinitis(Tables2-3).Rateoffreedomfromcardiacreinterventionduringthefollow-upperiodwas92.8%(13/14).ConclusionsTheinferiorJ-shapedsternotomyissimple,reproducible,andthesafesttechniqueforperformingminimallyinvasivecoronarybypasssurgery.MICAB+PCIisalsosafe,feasibleandefficacious.
