Non Conventional Coronary Surgery: Selective Revascularization of Right and Circumflex Coronary Arteries by Means of Mini-Invasive Techniques

pp 115-120

Abstract

Minimally invasive direct coronary artery bypass (MIDCAB) surgery for the left anterior descending (LAD) coronary artery without the use of cardiopulmonary bypass is a new therapeutic alter-native with less morbidity and similar results than the conventional approach. Two patients under-went MID CAB over territories other than the LAD coronary artery. Patient JC, was a 54 years old man with a previous history of myocardial infarction(MI), who had an episode of ventricular tachycardia and pulmonary edema. Myocardial viability studies were positive for ischemia over the inferior and lateral territories. Cardiac angiogram showed total occlusion of the right coronary artery(RCA) with an image of a good distal vessel, mini-mal lesions over LAD and CX arteries and moderate ventricular function. He underwent MIDCAB surgery over distal RCA using the gastroepiploic artery with good result. Patient RP, a 51 years old man with a previous history of MI and coronary bypass surgery presented with an episode of unstable angina (class II-III). Coronary angiogram showed patency of the previous left internal mammary artery bypass over the LAD, a patent vein graft over diagonal artery and occluded vein graft over RCA and CX arteries. Myocardial viability studies showed ischemia over CX territories and he under-went MIDCAB surgery over the CX artery using the radial artery with good results.

Conclusion

It is possible to perform MIDCAB surgery over different coronary territories as a localized treatment for a focal problem with less morbidity and similar therapeutic results than conventional methods.