Indications and patient selection in MIDCAB procedure via reversed-J inferior ministernotomy

Background: Minimal invasive coronary revascularisation can be performed less invasively by avoiding extracorporeal circulation and traditional longitudinal sternotomy. However, indications and patient selection criteria for MIDCAB procedures are still not well defined. We present our experiences with 180 MIDCAB procedures via reversed-J inferior ministernotomy regarding indications and patient selection. Methods: In a 4-year period (6/2005–9/2009), 180 patients (64±12years; w/m: 53/127) underwent MIDCAB with the left internal mammary artery (LIMA) anastomosed to LAD and/or the diagonal branch. LIMAs were skeletonized with ultrasonically activated scalpel. Flow in the bypass grafts was routinely measured with the transit-time method. Postoperative control of the grafts and the anastomoses was performed using cardiac CT imaging. Results: The indications for MIDCAB were single vessel disease (group I; n=105; 65±11 years; w/m: 29/76), selected multivessel disease for hybrid revascularisation in multimorbid patients or after emergency angioplasty (group II; n=47; 67±12 years; w/m: 11/36) and symptomatic myocardial bridging of LAD (group III; n=28; 57±13 years; w/m: 13/15). The LIMA flow per anastomosis was 40±20ml/min. Three cases of postoperative early graft failure were detected by cardio-CT. All other grafts were patent. The causes of graft failure were dissection, kinking, and twisting of IMA-grafts. Re-interventions were additionally necessary in 3 cases in group II at 1st and 4th day after surgery because of acute thrombotic total occlusion of intracoronary stents in left circumflex and right coronary arteries. Conclusions: MIDCAB via reversed-J inferior ministernotomy is a safe less invasive surgical technique with excellent results. Correct indication for operation and careful patient selection are crucial to maintain high quality of this approach.