Limited-access coronary artery bypass grafting. The Texas Heart Institute experience.

Limited-access coronary artery bypass grafting, without the aid of cardiopulmonary bypass, is being performed with increased frequency, but its indications are not well defined. To determine the outcome of, and indications for, this procedure, we analyzed our experience with limited-access coronary artery bypass grafting. Between February 1996 and June 1998, 84 patients underwent limited-access coronary artery bypass grafting at our institution. We retrospectively divided these patients into 2 groups: a high-risk group with complex disease and multiple comorbidities (n = 56), and a low-risk group with uncomplicated disease (n = 28). There were 2 perioperative deaths (2%), and both of them occurred in high-risk cases. Early and late complications included myocardial infarction (2 cases), recurrent angina necessitating revascularization (2 cases), and multisystem dysfunction (1 case). Compared with conventional bypass grafting, limited-access coronary artery bypass grafting offered a smaller skin incision, fewer arrhythmias, less blood loss, less need for inotropic drugs, shorter hospitalization, lower cost, and quicker recovery time. Limited-access coronary artery bypass grafting might have a role in treating high-risk patients who have complex disease and require single-vessel bypass. Anastomosis can be challenging, however, if the target coronary artery is small, calcific, or intramyocardial. Moreover, the long-term results are unknown. Therefore, nonselective use of limited-access coronary artery bypass grafting is unjustified.