Minimally invasive coronary artery bypass grafting without cardiopulmonary bypass: early experience and follow-up

1998 ◽  
Vol 66 (3) ◽  
pp. 1022-1025 ◽  
Author(s):  
Anno Diegeler ◽  
Volkmar Falk ◽  
Merajoddin Matin ◽  
Roberto Battellini ◽  
Thomas Walther ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Early Experience ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

The influence of gaseous microemboli on various biomarkers after minimized cardiopulmonary bypass

Perfusion ◽  
2019 ◽  
Vol 35 (3) ◽  
pp. 202-208
Author(s):  
Marco C Stehouwer ◽  
Roel de Vroege ◽  
Eline F Bruggemans ◽  
Frederik N Hofman ◽  
Meyke A Molenaar ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Interquartile Range ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Technology System

Introduction: Gaseous microemboli that originate from the cardiopulmonary bypass circuit may contribute to adverse outcome after cardiac surgery. We prospectively evaluated the influence of gaseous microemboli on the release of various biomarkers after use of a minimally invasive extracorporeal technology system. Methods: In 70 patients undergoing coronary artery bypass grafting with minimized cardiopulmonary bypass, gaseous microemboli were measured intraoperatively with a bubble counter. Intra- and postoperative biomarker levels for inflammatory response (interleukin-6, C5b-9), endothelial damage (von Willebrand factor, soluble vascular cell adhesion molecule-1), oxidative stress (malondialdehyde, 8-isoprostane, neuroketal), and neurological injury (neuron-specific enolase, brain-type fatty acid-binding protein) were analyzed using immune assay techniques. The relationship between gaseous microemboli number or volume and the incremental area under the curve (iAUC24h) or peak change for the biomarkers was calculated. Results: All biomarkers except for malondialdehyde increased at least temporarily after coronary artery bypass grafting with a minimally invasive extracorporeal technology system. The median total gaseous microemboli number was 6,174 (interquartile range: 3,507-10,531) and the median total gaseous microemboli volume was 4.31 µL (interquartile range: 2.71-8.50). There were no significant correlations between total gaseous microemboli number or volume and iAUC24h or peak change for any of the biomarkers. After controlling for the variance of possible other predictor variables, multiple linear regression analysis showed no association between gaseous microemboli parameters and release of biomarkers. Conclusion: This study showed no evidence that gaseous microemboli contribute to increased biomarker levels after coronary artery bypass grafting with cardiopulmonary bypass. A reason for the absence of damage by gaseous microemboli may be the relative and considerably small amount of gaseous microemboli entering the patients in this study.

Mid-Term Follow-Up of Minimally Invasive Multivessel Coronary Artery Bypass Grafting

2017 ◽  
Vol 12 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Maria Lorena Rodriguez ◽  
Harry R. Lapierre ◽  
Benjamin Sohmer ◽  
David Glineur ◽  
Marc Ruel
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Repeat Revascularization

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.

Predictors and Outcomes of Sternotomy Conversion and Cardiopulmonary Bypass Assistance in Minimally Invasive Coronary Artery Bypass Grafting

2016 ◽  
Vol 11 (5) ◽  
pp. 315-320 ◽  
Author(s):  
Maria L. Rodriguez ◽  
Harry R. Lapierre ◽  
Benjamin Sohmer ◽  
Jean-Philippe Ruel ◽  
Marc A. Ruel
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Objective This work's objective was to identify the determinants of conversion of minimally invasive coronary artery bypass grafting to sternotomy, with and without cardiopulmonary bypass assistance, and to compare clinical outcomes in patients who needed conversion. Methods This is a prospectively collected data on patients who underwent minimally invasive coronary bypass done by a single surgeon from February 2005 to September 2014. Statistical analyses were expressed as mean values ± standard deviation or proportions. Results The total number of patients was 266, with an average age of 62 years. The median number of grafted territories was 2, higher in those with pump assistance (median, 3 grafts; P ≤ 0.01). Predictors for use of cardiopulmonary bypass included diabetes, 3-vessel disease, left circumflex involvement, and small target vessels (P < 0.05). The rate for sternotomy conversion was 3.8%. Risk factors for conversion to sternotomy included smoking, preoperative bradycardia (<50 beats per minute), low intraoperative ejection fraction, inability to tolerate one-lung ventilation, inadequate surgical exposure, and hemodynamic instability. Postoperative complications included superficial thoracotomy infection (3%), sternotomy infection (10%), new atrial fibrillation (3%), and need for blood transfusion (14%). Twelve patients (5%) developed left-sided pleural effusion that required drainage. There were no perioperative deaths, major adverse cardiac event, or stroke. Conclusions Minimally invasive coronary bypass grafting with conversion to sternotomy and use of cardiopulmonary bypass is safe. Conversions may be alleviated by an effort to optimize modifiable risk factors and the adequacy of surgical exposure. These data may help develop objective selection criteria to identify patients who are excellent candidates for the procedure.

scholarly journals Long-term outcomes of off-pump minimally invasive coronary artery bypass grafting of the left anterior descending artery

2020 ◽  
Vol 24 (3) ◽  
pp. 62
Author(s):  
I. F. Shabaev ◽  
K. A. Kozyrin ◽  
R. S. Tarasov
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump

<p><strong>Aim.</strong> To evaluate the long-term results of off-pump minimally invasive direct coronary artery bypass grafting (MIDCAB) of the left anterior descending artery (LAD).<br /><strong>Methods.</strong> From 2011 to 2017, 146 patients with stable coronary artery disease and hemodynamically significant LAD disease who underwent minimally invasive coronary artery bypass grafting of the left internal mammary artery (LIMA) to the LAD were enrolled in this single-centre prospective study. Patients with significant stenosis of the left main coronary artery and those referred to a concomitant cardiac surgery were excluded. Of the 146 patients, 31 (19.8%) were lost to follow up. The average follow-up duration was 31.4 ± 20.9 mon. The study endpoints included death, myocardial infarction (MI), stroke, repeated myocardial revascularisation, and delayed wound healing.<br /><strong>Results.</strong> The rate of fatal outcomes within the follow-up period was 6% (n = 7). The MI incidence rate was 2.6% (n = 3). Of the three MIs, one was fatal. Stroke was registered in 6% (n = 7) of the patients. In one case, the stroke was fatal; 1.2% (n = 2) of the patients required repeat PCI with stenting. The length of stay in the intensive care unit following the index surgery was 1.0 ± 0.2 d. Total 108 (73.9%) patients were discharged within 10 d. There were no complications of delayed wound healing.<br /><strong>Conclusion.</strong> Thus, an analysis of the long-term treatment results (31.4 ± 20.9 months) showed satisfactory outcomes in patients with isolated LAD and multivascular coronary atherosclerosis, comparable to the results of standard coronary artery bypass grafting techniques. The survival rate of the patients was 94%, which, combined with the absence of wound complications in the hospital and the long-term follow-up period, provides evidence in favour of more active use of the MIDCAB technology as a popular option that allows successful revascularisation of the myocardium with minimally invasive access and off-pump technologies.</p><p>Received 16 April 2020. Revised 28 May 2020. Accepted 29 May 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

Sign in / Sign up

Export Citation Format

Share Document