Acute graft failure caused by an intracoronary shunt in minimally invasive direct coronary artery bypass grafting

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.

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Multiple minimally invasive direct coronary artery bypass grafting for the complete revascularization of the left ventricle

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(99)00473-7 ◽

1999 ◽

Vol 68 (1) ◽

pp. 131-136 ◽

Cited By ~ 16

Author(s):

Go Watanabe ◽

Takuro Misaki ◽

Keijyu Kotoh ◽

Kyousuke Kawakami ◽

Akio Yamashita ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Left Ventricle ◽

Minimally Invasive ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Complete Revascularization ◽

Bypass Grafting ◽

Artery Bypass Grafting

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Myocardial damage after minimally invasive coronary artery bypass grafting on the beating heart

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(98)00733-4 ◽

1998 ◽

Vol 66 (3) ◽

pp. 1093-1096 ◽

Cited By ~ 24

Author(s):

Johannes Bonatti ◽

Herbert Hangler ◽

Christoph Hörmann ◽

Johannes Mair ◽

Jürgen Falkensammer ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Minimally Invasive ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Myocardial Damage ◽

Beating Heart ◽

Bypass Grafting ◽

Artery Bypass Grafting

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Hybrid minimally invasive multivessel coronary artery bypass grafting to achieve complete myocardial revascularisation: the first clinical case

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2020-3s-108-118 ◽

2020 ◽

Vol 24 (3S) ◽

pp. 108

Author(s):

I. F. Shabaev ◽

K. A. Kozyrin ◽

R. S. Tarasov

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Minimally Invasive ◽

Coronary Artery Bypass ◽

Conflict Of Interest ◽

Graft Failure ◽

Clinical Case ◽

Artery Bypass ◽

Bypass Grafting ◽

Myocardial Revascularisation

Aim. To report the first clinical case of the hybrid procedure combining off-pump minimally invasive multivessel coronary artery bypass grafting (MICS-CABG) and percutaneous coronary intervention (PCI) of the obtuse marginal (OM) artery to achieve complete myocardial revascularisation.Clinical case. Bilateral in situ skeletonised left internal mammary artery (IMA) grafting to the left anterior descending artery was performed, and a Y-shape anastomosis was created from the left IMA-right IMA to the circumflex branch. At 2 hours postoperatively, graft failure caused by subtotal stenosis at the graft was diagnosed. Reconstruction of the anastomosis improved the transit time flow measurement by 3.5 hours postoperatively. Acute myocardial infarction did not develop. On postoperative day 1, graft patency was assessed, and then the OM stent was placed. On postoperative day 8, the patient was discharged and referred to the outpatient centre for further treatment and rehabilitation. Hybrid revascularisation offers the advantages of both CABG and PCI; however, the technical complexity is a major limitation for its widespread use. This case reports the development of adverse events during the surgeon's training to perform this nonstandard technology. Timely diagnosis of the initial graft failure and surgical revision led to a successful and complication-free outcome and avoided prolonged patient rehabilitation.Conclusion. Hybrid revascularisation combining MICS-CABG and PCI with new-generation drug-eluting stents can be a worthwhile alternative to conventional multivessel CABG with minimal invasiveness and complete revascularisation.Received 5 June 2020. Revised 10 September 2020. Accepted 15 September 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

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