Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598808
Oral Presentations
Monday, February 13th, 2017
DGTHG: Coronary Heart Disease: Off-pump ./. On-pump
Georg Thieme Verlag KG Stuttgart · New York

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) via Inferior Sternotomy: A “Gold Standard” Therapy for Single LAD Muscle Bridging?

A. Ghazy
1   Johannes Gutenberg University, Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
,
A. Abugameh
2   Johannes Gutenberg University, Mainz, Germany
,
J. Misic
1   Johannes Gutenberg University, Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
,
K. Buschmann
1   Johannes Gutenberg University, Herz-, Thorax- und Gefäßchirurgie, Mainz, Germany
,
A. Beiras-Fernandez
2   Johannes Gutenberg University, Mainz, Germany
,
C.F. Vahl
2   Johannes Gutenberg University, Mainz, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

   All articles of this category

Introduction: Muscle bridging is a congenital condition defined as the intra-myocardial course of a portion of a coronary artery. During systolic contraction, the underneath coronary artery is narrowed which might cause myocardial infarction and sudden cardiac death. Until now conservative and interventional therapies failed with poor outcomes. MIDCAB surgery has been suggested as the treatment of choice in single LAD muscle bridging. This retrospective study was designed to evaluate technical feasibility of MIDCAB for the treatment of this anomaly and to determine its long term outcome.

Methods: From 2005 until 2014, we included 44 consecutive patients (59.1 ± 13.1 years, 26 males) who underwent elective MIDCAB surgery in single LAD muscle bridging. MIDCAB was performed via inferior sternotomy using the left internal mammarian artery (LIMA) as bypass graft without cardiopulmonary bypassing (CPB). After 64.4 ± 24.5 months all patients were reevaluated.

Results: Preoperatively, 28 cases (64%) complained of chest pain, 16 (36%) of chest distress. Mean BMI was 26.9 ± 3.8. EuroScore II was 1.7 ± 1.9. Mean operative times were 140 ± 40.5 minute. No conversion to full sternotomy or CPB was necessary. Survival was 100%. Mean hospital stay was 7.6 ± 3.9days. Routinely performed computed tomography at day 6 revealed (97.7%) graft patency. During the initial hospital stay, one patient (2.3%) was re-operated due to early graft failure. During re-evaluation, all patients were alive, had no re-operations and were free of pain. Nine patients (18.7%) underwent diagnostic coronary angiography 17 ± 7 months postoperative; which showed bypass grafts patency. No wound healing disturbances was detected.

Conclusion: Our data suggests that MIDCAB surgery is a safe and efficient procedure for the treatment of single LAD Bridging. The low rate of complications, cosmetic benefits and patency rates documented, support this conclusion.