Pii: S1010-7940(99)00265-1

Objectives: The technical aspects of minimal invasive surgery are discussed, together with a comparison of off-pump MIDCAB with offpump sternotomy, with special respect to outcomes of death, infarct and anastomoses. Methods: Technical aspects of beating heart surgery are described under the headings: Trauma; Access; Stabilisation; Ischaemia; Haemostasis; Suturing; and Circulatory support. Data from papers and meetings on minimal invasive surgery were collated to September 1998 and correlated with the unit of origin. Percentage ®gures were back calculated to provide an actual number from which a new data base was obtained relevant to the reporting incidence. For statistical analysis a Chi squared test with Yates correction was used. Results: Sixty-three centres reported 3304 cases of MIDCAB surgery (M) and 21 centres reported over 3060 cases of off-pump surgery through a sternotomy (S). There was no difference in early or late death rates between the two groups (1.6% M:2.2% S). There was a higher infarct rate with MIDCAB (2.9% M:1.45% S; P , 0:03). The occlusion and stenosis rates for MIDCAB were 3.9 and 6.6% whilst for sternotomy off-pump they were 4.9 and 1.4%. The stenosis difference was signi®cant at the P , 0:001 level. A combined occlusion and stenosis rate showed a higher incidence with MIDCAB (10.5%), than sternotomy 6.4% (P , 0:08). Four major series showed comparative data before and after stabiliser usage in MIDCABs. The stenosis rate was signi®cantly reduced with stabilisation from 9.6 to 3.7% (P , 0:002) as was the combined occlusion and stenosis rate from 16 to 5.0% (P , 0:0001). In the total series there was no signi®cant difference in length of stay (4.6 days), incidence of atrial ®brillation (9%), or between conversion to sternotomy(MIDCAB group) or to bypass (sternotomy group) (5%) between the two groups (M and S). Grafting the right coronary artery by MIDCAB produced worse results than for the left anterior descending artery (LAD). Conclusions: There is an important failure rate with beating heart surgery; stabilisers reduce this risk and are essential tools in both MIDCAB and beating heart surgery and encourages the further use of minimally invasive approaches. q 1999 Elsevier Science B.V. All rights reserved.