Minimally Invasive Surgical Technique for the Treatment of Multivessel Coronary Artery Disease

Background. To avoid sternotomy-related complications after cardiac operations, we developed a minimally invasive surgical technique for the treatment of multivessel coronary artery disease. Methods. From November 1996 to May 1997, 39 patients (age range, 50 to 78 years) with coronary artery disease were treated with the use of this technique. Through a small (6- to 9-cm) left lateral chest incision in the third intercostal space, the left internal mammary artery was harvested directly. With the use of cardiopulmonary bypass and cardioplegic arrest in all patients except 1, the left internal mammary artery was anastomosed to the left anterior descending artery. In addition, vein grafts and other arterial conduits were used for revascularization of the other coronary arteries. Results. There were no intraoperative complications. All the patients survived the procedure and had an uneventful postoperative course. Wound complications occurred in 2 patients. The median (± standard error of the mean) hospital stay was 6 ± 1 days. Conclusions. This technique combines minimally invasive surgical conditions with the safety standards of routine cardiac operations. With the use of this approach, even extensive coronary artery disease can be treated.