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Minimally invasive cardiac surgery

BMJ 1999; 319 doi: (Published 17 July 1999) Cite this as: BMJ 1999;319:135

Offers ways of reducing the complications of coronary artery bypass grafts

  1. Brian Glenville, Consultant cardiothoracic surgeon
  1. St Mary's NHS Trust, London W2 1NY

    Coronary artery bypass grafts, performed to alleviate blockages or stenoses in coronary arteries, have come a long way since the mid-1960s. The first operations performed were left internal mammary artery anastomoses to the left anterior descending artery by Kosolov in Leningrad and by Favalore at the Cleveland Clinic. Coronary artery bypass grafting then spread rapidly throughout the world. Nevertheless, it remains a major operation with significant complications, and surgeons have sought new ways of reducing the insult to the patient. A variety of minimally invasive techniques offer some promise.

    Innovations over the 30 years since coronary artery bypass grafts were first developed have included greater use of arterial conduits, better methods of cardioprotection, and improvements in oxygenator technology. This last area has seen transition through plate, bubble, and membranes to hollow fibre oxygenator technology. The cardiopulmonary bypass circuit has got safer and better, but important pathophysiological consequences still remain for the patient. A 50 year old man has a 0.7% chance of suffering a stroke on cardiopulmonary bypass, and the risk rises to 8% …

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