Minimally Invasive Direct Coronary Artery Bypass Surgery
MIDCAB procedures have been performed successfully on selected
patients through a left thoracotomy.[332]
[333]
[334]
Clearly, the approach is limited to patients
with amenable coronary anatomy. The potential advantages and disadvantages of this
approach are summarized in Table 50-23
.
Not surprisingly but of concern, a series involving 274 patients demonstrated an
adverse cardiac event rate of
6% in the last 174 patients compared with 11% in the first 100 patients.[335]
This difference did not reach statistical significance but still illustrates the
learning curve involved. Indications for MIDCAB and its place relative to other
approaches continue to evolve, and it is currently practitioner and institution dependent.
