The MIDCAB surgery - minimally invasive alternative to the open-heart surgery in one-vessel disease

Abstract

Introduction: Minimally invasive direct coronary artery bypass (MIDCAB) is an established surgical procedure for revascularisation of the coronary arteries. MIDCAB has been mainly used in patients with proximal stenosis of the left anterior descending artery (LAD). The MIDCAB technique with approach through the left anterior small thoracotomy resulted in effective LIMA(left internal mam­mary artery)-to-LAD grafting. The MIDCAB technique carries a very low rate of complications and restenosis. By avoiding sternotomy and cardiopulmonary bypass it is less invasive than conventional bypass surgery. It reduces surgical trauma and gives a satisfying cosmetic effect. Materials and Methods: A case report of a 64-year-old man with single-vessel coronary artery disease, angina pectoris class III NYHA, hypertension class III, hyperlipidemia, left ventricular hypertrophy who was admitted to the Department of Cardiac Surgery, complaining of breathlessness, chest pain and fatigue during physical effort. The symptoms relieved after 5-10 minutes rest. The patient under­went Coronary angiography which shows chronic total occlusion of LAD and an unsuccessful attempt for percutaneous coronary intervention (PCI) in the past. The patient was considered as suitable for MIDCAB surgery in planned order. Results: The patient tolerated the operation with stable haemodynamics. The blood flow in the LAD was restored with LIMA-to-LAD graft and the positive result was proven by flowmetry in the oper­ation theatre. The patient was extubated on the 3rd postoperative hour. No rhythm and conduction disorders were registered. Conclusion: MIDCAB surgery is a suitable alternative to the conventional open-heart bypass sur­gery. It is not only applicable in isolated lesions of the LAD but also with the Hybrid concepts (MID­CAB and PCI) it is of growing interest in serving older patients with significant comorbidities. Over­all, MIDCAB surgery is associated with few perioperative complications, psychological and surgical trauma and with high graft patency rates in the mid-term and long-term course.