Incisions for coronary revascularization

2021 ◽  
pp. 315-318
Author(s):  
Valavunar A. Subramanian ◽  
Nirav C. Patel
Keyword(s):  
Cardiopulmonary Bypass ◽  
Minimally Invasive ◽  
Coronary Arteries ◽  
Coronary Revascularization ◽  
Median Sternotomy ◽  
Beating Heart ◽  
Direct Vision ◽  
Left Anterior Descending Artery ◽  
Complete Access

The most commonly performed incision for coronary revascularization is median sternotomy as it allows complete access to all target vessels and safe establishment of cardiopulmonary bypass. For targeted revascularization, various minimally invasive incisions can be used to access the left anterior descending artery, marginal arteries, and right coronary arteries in isolation. Grafting is then performed on the beating heart under direct vision.

Multimodality Targeted Approach in Redo Off-Pump Coronary Artery Bypass Surgery

2003 ◽  
Vol 11 (1) ◽  
pp. 7-10 ◽  
Author(s):  
Yugal K Mishra ◽  
Harpreet Wasir ◽  
Surendra N Khanna ◽  
Sameer Shrivastava ◽  
Yatin Mehta ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Myocardial Revascularization ◽  
Off Pump ◽  
Left Anterior Descending Artery ◽  
The Mean ◽  
Targeted Approach

Records of 86 patients who underwent off-pump redo coronary revascularization between December 1997 and December 2000, were analyzed. Approaches included median sternotomy (47), anterolateral thoracotomy for left anterior descending artery and diagonal targets (35), posterolateral thoracotomy for the obtuse marginal with proximal anastomosis on descending aorta (3), and a combined subxiphoid-anterior thoracotomy approach (1) for right gastroepiploic artery-to-left anterior descending artery anastomosis. The mean age was 61.82 years. There were 2 (2.3%) operative deaths. Complications included perioperative myocardial infarction in 4 patients and reexploration for bleeding in one. Blood transfusion was required in 12 patients. The mean length of hospital stay was 5 ± 2 days. A multimodality targeted approach for off-pump redo coronary artery bypass offers a less invasive but safer method of myocardial revascularization, with decreased complications, lower blood product requirement, and early hospital discharge.

scholarly journals Review of Contemporary Techniques for Minimally Invasive Coronary Revascularization

2021 ◽  
pp. 155698452110107
Author(s):  
Ali Fatehi Hassanabad ◽  
Jimmy Kang ◽  
Andrew Maitland ◽  
Corey Adams ◽  
William D. T. Kent
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Technical Difficulty ◽  
Surgical Revascularization ◽  
Current State ◽  
Future Potential

Minimally invasive coronary revascularization techniques aim to avoid median sternotomy with its associated complications, while facilitating recovery and maintaining the benefits of surgical revascularization. The 3 most common procedures are minimally invasive coronary artery bypass grafting, totally endoscopic coronary artery bypass, and hybrid coronary revascularization. For a variety of reasons, including cost and technical difficulty, not many centers are routinely performing minimally invasive coronary revascularization. Nevertheless, many studies have assessed the safety and efficacy of each of these procedures in different clinical contexts. Thus far results have been promising, and with the evolution of procedural techniques, these approaches have the potential to redefine coronary revascularization in the future. This review highlights the current state of minimally invasive coronary revascularization techniques by exploring their benefits, identifying barriers to their adoption, and discussing future potential paradigms.

scholarly journals Hybrid coronary revascularization with endoscopic closed-chest arterial coronary bypass technique (endo-CABG)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Claessens ◽  
S Van Genechten ◽  
A Kaya ◽  
A Yilmaz
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Disease ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Hybrid Approach ◽  
Funding Source ◽  
Arterial Revascularization ◽  
Hybrid Coronary Revascularization

Abstract Introduction Treatment of three-vessel coronary disease in minimally invasive manner could be complex in some cases. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) gives good patency rates which outlive vein grafts. The hybrid approach, combination of PCI with minimally invasive endoscopic coronary artery bypass graft (endo-CABG), might be a valuable option for treatment of multivessel coronary disease. Hereby we describe our series of patients undergoing arterial revascularization of the anterior and/or lateral wall combined with PCI of the right coronary artery or a marginal branch. Methods From March 2013 until December 2019, 208 patients (82.2% males, mean age: 66.69±10.44 years) underwent hybrid coronary revascularization for multivessel disease. Patients with multivessel disease suitable for hybrid approach were accepted at the heart team. All patients received total arterial revascularisation by endo-CABG. The PCI was prior or after the endo-CABG. There was no discontinuation of dual platelet therapy. Uni or bilateral internal mammary artery (IMA) harvesting was performed through three 5mm endoscopic ports in the 2nd, 3rd and 4th intercostal space. Cardiopulmonary bypass was established using a minimally invasive extracorporeal circulation (MiECC) with groin cannulation. Transthoracic aortic cross-clamping was followed by antegrade administration of a single shot cold mixed blood cardioplegia. A utility port of three centimeter was used for direct vision anastomosis. Results The procedure was successful in all patients, requiring no conversion to full sternotomy. Mean cross-clamping and cardiopulmonary bypass times were 44.38±28.33 and 91.75±37.97 minutes, respectively, with a mean of 2.1±0.91 bypasses for each patient. All patients received total arterial revascularization. The mean ICU and hospital length of stay were 62.5±39.74 hours and 8.80±4.64 days, respectively. Average postoperative blood loss over 24 hours was 555.20±859.19 mL. There were 8 re-interventions on the target vessels (3.8%) and 2 patients suffered from a stroke (1%). The 30-day mortality rate was 0.5%. Conclusion Minimally invasive hybrid arterial coronary revascularization is a safe and valuable alternative to coronary artery bypass grafting in many patients with multivessel coronary artery disease. The endo-CABG is a safe and feasible technique without compromising operative morbidity and providing good postoperative results. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Jessa Hospital

scholarly journals Robotic off-pump hybrid coronary revascularization - a niche area in need for objective data.

2022 ◽  
Author(s):  
Pradeep Narayan ◽  
Gianni Angelini
Keyword(s):  
Bypass Surgery ◽  
Internal Thoracic Artery ◽  
Coronary Revascularization ◽  
Median Sternotomy ◽  
Coronary Bypass ◽  
Beating Heart ◽  
Objective Data ◽  
Off Pump ◽  
Niche Area ◽  
Hybrid Coronary Revascularization

Hybrid coronary revascularization (HCR) consists of left internal thoracic artery (LITA) graft to the left anterior descending (LAD) artery and transcatheter revascularization of the non-LAD stenosis in specific settings to achieve complete coronary revascularization. Technique to perform the LITA to LAD graft has ranged from median sternotomy with cardiopulmonary bypass to robotically assisted totally endoscopic coronary bypass surgery using beating heart revascularization.

Minimally invasive coronary revascularization through parasternal incisions without cardiopulmonary bypass

1997 ◽  
Vol 63 (6) ◽  
pp. S53-S56 ◽  
Author(s):  
Rex De L. Stanbridge ◽  
Leonidas K. Hadjinikolaou ◽  
Andrew S. Cohen ◽  
Rodney A. Foale ◽  
Wyn D. Davies ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Minimally Invasive ◽  
Coronary Revascularization

Surgical Technique: Papillary Muscle Sling for Functional Mitral Regurgitation during Minimally Invasive Valve Surgery

2013 ◽  
Vol 16 (5) ◽  
pp. E295-E297 ◽  
Author(s):  
Joseph Lamelas ◽  
Christos Mihos ◽  
Orlando Santana
Keyword(s):  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Rational Approach ◽  
Functional Mitral Regurgitation ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Mitral Annuloplasty ◽  
Technical Details ◽  
Mitral Apparatus

In patients with functional mitral regurgitation, the placement of a sling encircling both papillary muscles in conjunction with mitral annuloplasty appears to be a rational approach for surgical correction, because it addresses both the mitral valve and the deformities of the subvalvular mitral apparatus. Reports in the literature that describe the utilization of this technique are few, and mainly involve a median sternotomy approach. The purpose of this communication is to describe the technical details of performing this procedure via a minimally invasive approach.

scholarly journals Totally endoscopic mitral valve surgery: early experience in 188 patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yi Chen ◽  
Ling-chen Huang ◽  
Dao-zhong Chen ◽  
Liang-wan Chen ◽  
Zi-he Zheng ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Disease ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Endoscopic Technique ◽  
Venous Cannula ◽  
Defect Repair

Abstract Introduction Totally endoscopic technique has been widely used in cardiac surgery, and minimally invasive totally endoscopic mitral valve surgery has been developed as an alternative to median sternotomy for many patients with mitral valve disease. In this study, we describe our experience about a modified minimally invasive totally endoscopic mitral valve surgery and reported the preliminary results of totally endoscopic mitral valve surgery. The aim of this retrospective study is to evaluate the results of totally endoscopic technique in mitral valve surgery. Material and methods We retrospectively reviewed the profiles of 188 patients who were treated for mitral valve disease by modified totally endoscopic mitral valve surgery at our institution between January 2019 and December 2020. The procedure was performed under endoscopic right minithoracotomy and with femoro-femoral cannulation using the single two-stage venous cannula. Results A total of 188 patients underwent total endoscopic mitral valve surgery. Fifty-six patients had concomitant tricuspid valvuloplasty, 11 patients underwent concomitant ablation of atrial fibrillation and atrial septal defect repair was performed in three patients. Only one patient postoperatively died of multi-organ failure. Two patients were converted to median sternotomy. Except for one patient underwent operation to stop the bleeding from the incision site, no other serious complications nor reintervention occurred during the follow-up period. Conclusions The modified totally endoscopic mitral valve surgery performed at our institution is technically feasible and safe with the same efficacy as reported studies.

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