جراحي باي پس كرونر به روش كم تهاجم ويديويي در بيمارستان قايم مشهد (79-1375)

Video-Assisted Minimally Invasive Direct Coronary Artery Bypass (M1DCAB) in Ghaem Hospital (1996-2000)

Minimally invasive direct coronary artery bypass (MIDCAB) is a new surgical procedure that revascularize the left anterior descending coronary artery (LAD) without the need for a median sternotomy or cardiopulmonary bypass (CPB). This operation is performed through a left anterior small thoracotomy (LAST). From December 1997 to December 2000, twenty two patients with isolated left anterior descending artery stenosis recognized by coronary angiography received left internal mammary artery grafting through a 4 cm, left anterior minithoracotomy, the mean age was 56 years (range, 25 to 76 years), 17 patients were men. LIMA is harvested under thoracoscopic guidance. This approach allows complete dissection of the LIMA from the subclavian artery to the fifth intercostal space. Coronary artery control is obtained with looping suture placed proximally to the site of the anastomosis. Anastomosis is then performed with 8/0 prolene on the beating heart, under direct vision without CPB. LIMA was used in all of cases. There were no operative complications and preoperative myocardial infarctions. Supraventricular and ventricular arrhythmias were never detected. Average operative time was 3 hours with shortened hospital stay. Minimally invasive direct coronary artery bypass grafting through a small anterior thoracotomy is a new promising technique that can be considered an alternative to myocardial revascularization. The procedure is safe and effective; these results are equivalent to conventional CABG. Then, the potential benefits of these approaches include: surgical invasiveness is limited, cardiopulmonary bypass risks and morbidities due to median sternotomy are avoided, blood loss is less and hospital stay is shorter, reduced costs and finally good cosmetic results on chest wall.