Key result
Minimally invasive bypass grafting without cardiopulmonary bypass is increasingly used for single vessel disease, but concerns remain regarding its use in multivessel disease and anastomosis quality.
Discusses the expanding indications for minimally invasive bypass grafting and the hybrid technique, while noting ongoing surgeon skepticism regarding anastomosis quality on a beating heart.
May warrant selective use in single-vessel disease; leaves open multivessel applicability and anastomosis durability.
Minimally invasive bypass grafting of the internal thoracic artery to the left anterior descending artery has become routine in many institutions. Currently, indications for single vessel revascularization are expanding to those patients not suitable to be operated upon using extracorporeal circulation, but surgeons remain rather reluctant when multivessel disease is concerned. In such cases, the 'hybrid technique', i.e. single vessel bypass grafting followed by percutaneous transluminal coronary angioplasty at a different site, seems to be a more appropriate alternative. Despite the merits of minimally invasive surgery, the majority of surgeons do not believe that it is possible to achieve the same quality of anastomosis on a beating heart as on an arrested heart.
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Scheld et al. (1998) conducted a review in Coronary artery disease requiring revascularization. Minimally invasive bypass grafting without cardiopulmonary bypass vs. Conventional bypass grafting with extracorporeal circulation was evaluated. Minimally invasive bypass grafting without cardiopulmonary bypass is increasingly used for single vessel disease, but concerns remain regarding its use in multivessel disease and anastomosis quality.