Minimally invasive coronary artery bypass grafting: useful routine option for coronary revascularization in selected cases

2020 ◽  
Vol 68 (10) ◽  
pp. 1128-1133
Author(s):  
Taichi Sakaguchi ◽  
Toshinori Totsugawa ◽  
Kentaro Tamura ◽  
Arudo Hiraoka ◽  
Masaaki Ryomoto ◽  
...  
Author(s):  
Maria Lorena Rodriguez ◽  
Harry R. Lapierre ◽  
Benjamin Sohmer ◽  
David Glineur ◽  
Marc Ruel

Objective Minimally invasive coronary artery bypass grafting (MICS CABG) through a small left thoracotomy is a novel technique for surgical coronary revascularization, which is increasingly being adopted around the world. This study aimed to describe the characteristics and mid-term outcomes of a series of MICS CABG to identify areas for improvement. Methods A prospective longitudinal study was performed on the 306 MICS CABG patients operated on by a single surgeon from 2005 to 2015. Minimally invasive coronary artery bypass grafting used a small left thoracotomy to enable coronary revascularization with a similar configuration to an open sternotomy technique, with left internal thoracic artery harvesting, and hand-sewn proximal radial/saphenous and distal anastomoses, under direct visualization. We compared patients who were operated on during the first and second halves of the series to ascertain the impact of a learning curve on outcomes. Results The mean ± SD age was 62 ± 9 years, 87% were male, and 23% had three-vessel disease. Off-pump coronary artery bypass was performed in 80%, and the median number of grafts was 2 (range 1–4). Sternotomy conversion occurred in 3.3%, reoperation for bleeding in 2%, and unplanned, emergency CPB conversion in 1%. Superficial thoracotomy infection, atrial fibrillation, and left-sided pleural effusion requiring drainage were encountered in 2%, 1%, and 1%, respectively. There were no perioperative stroke, myocardial infarction, or death. At a mean ± SD follow-up of 2.8 ± 2.5 years, 97.4% of patients were free from major adverse cardiac and cerebrovascular events. Between the first and latter half of the series, there was a decrease in the rate of conversion to sternotomy (5.2%–1.3%, P = 0.05) and in the mid-term need for repeat revascularization (11% vs 2.6%, P = 0.03). Overall repeat revascularization rate was 2.5% per year. The intensive care unit and hospital lengths of stay (1.6 ± 1.5 vs 1.4 ± 0.9, P = 0.2, and 6.1 ± 2.6 vs 5.6 ± 1.8, P = 0.4) were not statistically different. Conclusions Minimally invasive coronary artery bypass grafting can be safely initiated as a minimally invasive, multivessel alternative to open surgical coronary revascularization, with excellent mid-term results. Learning phase effects were not observed with regard to overall procedural safety, but rather in terms of improved freedom from conversion to sternotomy and from repeat revascularization.


2004 ◽  
Vol 7 (6) ◽  
pp. E533-E534 ◽  
Author(s):  
Timothy P. Martens ◽  
Marco M. Hefti ◽  
Robert Kalimi ◽  
Craig R. Smith ◽  
Michael Argenziano

2018 ◽  
Vol 67 (06) ◽  
pp. 437-443 ◽  
Author(s):  
Mahmoud Diab ◽  
Gloria Färber ◽  
Christoph Sponholz ◽  
Raphael Tasar ◽  
Thomas Lehmann ◽  
...  

Abstract Background Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) is associated with the best long-term survival. However, using BITA increases the risk of sternal wound infections with conventional sternotomy. We describe here our initial results of minimally invasive CABG (MICS-CABG) using BITA. Methods Patients were operated through an incision similar to that of standard minimally invasive direct CABG. All operations were performed off-pump. We evaluated patient's quality of life (QoL) using the Medical Outcomes trust, 36-Item Short Form Health Survey (SF-36). Results Between February 2016 and August 2017, we performed 21 cases of MICS-CABG using BITA. There was no intraoperative complication and no conversion to sternotomy or to on-pump. Two patients required reexploration through the same minithoracotomy for postoperative bleeding. Two cases of early postoperative graft failure were identified. There was no stroke or in-hospital mortality. The median duration of follow-up was 13 months, with a maximum of 19 months. Relief of angina was achieved in all patients. There was one readmission for superficial wound infection, which was conservatively treated. An 84-year-old man died 4 months after the operation. The remaining 20 patients attested good QoL with the SF-36 questionnaire. Conclusions Myocardial revascularization using BITA can be safely achieved off-pump through a left-sided minithoracotomy with good postoperative and short-term outcomes.


1998 ◽  
Vol 66 (3) ◽  
pp. 1093-1096 ◽  
Author(s):  
Johannes Bonatti ◽  
Herbert Hangler ◽  
Christoph Hörmann ◽  
Johannes Mair ◽  
Jürgen Falkensammer ◽  
...  

State of the Art Surgical Coronary Revascularization is an authoritative textbook dedicated to the art and science of surgical coronary revascularization, with 71 chapters, organized in nine sections, and written by over 100 recognized world experts. The textbook covers every aspect of the surgical management of coronary artery pathology and ischaemic heart disease. It provides extensive sections detailing pathophysiology, evaluation, and medical and percutaneous management of ischaemic heart disease as well as general outcomes and quality assessment for coronary artery bypass grafting. Pre-, intra- and postoperative management of coronary artery bypass graft patients is emphasized in detail as are the core surgical principles in the conduct of coronary artery bypass grafting, with special focus on the selection of conduits and how to optimize the performance of both on- and off-pump surgery to reduce morbidity and mortality. There are detailed sections on how to improve outcomes with both arterial and venous bypass grafts.


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