Beating Heart Totally Endoscopic Coronary Artery Bypass

Background: Graft patency and clinical freedom from graft failure remains a subject of investigation in beating-heart totally endoscopic coronary artery bypass.

Methods: A total of 214 patients underwent successful beating-heart totally endoscopic coronary artery bypass from July 2004 to June 2007. Single-, double-, and triple-vessel beating-heart totally endoscopic coronary artery bypass was performed in 139, 68, and 7 patients, respectively. Fifty patients underwent planned hybrid revascularization. Eighty percent of patients (172 of 214) underwent computed tomography angiography or conventional angiography within 3 months from the time of surgery. On computed tomography angiography, the analysis included gross patency, stenosis within the graft, and contrast in the grafted coronary artery. A FitzGibbon score was used to analyze graft patency and anastomosis in patients undergoing conventional angiography. Clinical follow-up was done in all patients for any major adverse cardiac event in relation to the revascularized coronary arteries.

Results: There was no myocardial infarction, operative mortality, or conversion to cardiopulmonary bypass. All patients who had computed tomography angiography were found to have grossly patent graft without stenosis and demonstrated opacification of the grafted coronary artery. Fifty-seven grafts were studied in 39 patients by conventional angiography postoperatively during hybrid revascularization. At the time of study, all grafts except one had FitzGibbon grade A anastomosis and Thrombolysis In Myocardial Infarction grade 3 flow. Three patients (1.4%) required reintervention at 2, 3, and 13 months after initial beating-heart totally endoscopic coronary artery bypass.

Conclusions: The clinical freedom from graft failure noted in 98.6% patients appears to be excellent. Further angiographic and clinical follow-up is required to determine the long-term results.