Minimally Invasive Coronary Artery Bypass as a Salvage Procedure

1998 ◽  
Vol 6 (1) ◽  
pp. 62-63
Author(s):  
Rajneesh Malhotra ◽  
Yugal Mishra ◽  
Pankaj Maheshwari ◽  
Yatin Mehta ◽  
Naresh Trehan
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Left Internal Mammary Artery ◽  
Femoral Vein ◽  
Artery Bypass ◽  
Hemodynamic Instability ◽  
Salvage Procedure ◽  
Life Saving ◽  
Internal Mammary

A 58-year-old male patient undergoing for coronary reoperative surgery had hemodynamic instability associated with intractable ventricular fibrillation after induction of anesthesia before starting the surgery. Minimally invasive coronary artery bypass surgery with left internal mammary artery-to-left anterior descending coronary artery anastomosis under percutaneous left femoral artery-to-left femoral vein cardiopulmonary bypass was employed successfully as a life saving measure.

scholarly journals On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study

2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Muhammad Sher-i-Murtaza ◽  
Mirza Ahmad Raza Baig
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Hemodynamic Instability ◽  
Bypass Grafting ◽  
Operative Strategy ◽  
Internal Mammary

Objective: To evaluate the clinical safety of left internal mammary artery (LIMA) harvesting in hemodynamically unstable patients after establishing cardiopulmonary bypass (CPB) in isolated coronary artery bypass graft (CABG) surgery. Methods: The prospective observational study was conducted at Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, from December 2016 to August 2018. All patients undergoing isolated CABG surgery in which LIMA conduit was harvested after establishing cardiopulmonary bypass because of hemodynamic instability at induction of anaesthesia or during surgery were included in the study. Preoperative, operative and postoperative characteristics of the patients were recorded. Data was analyzed using SPSS 19. Results: In Forty nine patients including 39 male and 10 female, early CPB had to be established because of hemodynamic instability and afterwards LIMA was harvested. Out of 49, 30 patients presented with CCS class III angina. 37 (75.5%) patients were scheduled on elective coronary surgery waiting list. There were 39 (79.59%) patients who weaned off bypass on mild inotropic support and 4 (8.16%) patients needed IABP support. All patients had multi-vessel coronary artery disease. Mean number of grafts were 3.428±0.577, CPB time was 110.59±25.594 and hospital stay was 5.367±1.424. Conclusions: The study showed that LIMA can be safely harvested in unstable patients after establishing extracorporeal circulation and by using this operative strategy in patients who need urgent or emergent surgical coronary revascularization LIMA can be safely used as a conduit. doi: https://doi.org/10.12669/pjms.35.3.988 How to cite this:Sher-i-Murtaza M, Baig MAR. On pump harvesting of Left Internal Mammary Artery (LIMA) in unstable patients undergoing coronary artery bypass grafting (CABG) is a safe operative strategy: A pilot study. Pak J Med Sci. 2019;35(3):---------.  doi: https://doi.org/10.12669/pjms.35.3.988 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Iatrogenic Aortocoronary Arteriovenous Fistula following Coronary Artery Bypass Surgery: A Case Report and Complete Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Jonathan D. Gardner ◽  
William R. Maddox ◽  
Joe B. Calkins
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Rare Complication ◽  
Artery Bypass ◽  
Coronary Vein ◽  
Arteriovenous Fistulas ◽  
Asymptomatic Patients ◽  
Internal Mammary

The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.

scholarly journals Post Coronary Artery Bypass Grafting Failure—Don’t Always Blame the Blues!!

2019 ◽  
Vol 12 ◽  
pp. 117954761982871
Author(s):  
Akshyaya Pradhan ◽  
Vikas Gupta ◽  
Monika Bhandari ◽  
Pravesh Vishwakarma ◽  
Rishi Sethi
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Arterial Grafts ◽  
Artery Bypass Grafting ◽  
Venous Grafts ◽  
Internal Mammary

Long term outcomes following coronary artery bypass grafting are governed by patency of vascular grafts. In this regard, the use of arterial grafts, (preferably the left internal mammary artery) has demonstrated improved survival relative to their venous counterparts. These benefits are a consequence of greater patency of LIMA at 10 years vis-a-vis venous grafts. Uncommonly, there is a possibility of occlusion of LIMA early in the post operative period due to procedural reasons but late occlusion of LIMA is rare. We report an unusual case of late occlusion of LIMA after seven years of CABG.

scholarly journals Postoperative Early Outcomes of Conventional versus Minimally Invasive Multivessel Coronary Artery Bypass Surgery: Retrospective Study

2021 ◽  
pp. 30-35
Author(s):  
Elif Erdogan ◽  
Gokhan Gokarslan ◽  
Feragat Uygur ◽  
Murat Yardımcı ◽  
Erkan Kaya ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Conventional Method ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Surgical Techniques ◽  
University Hospital ◽  
Aortic Cross Clamp Time ◽  
Duration Of Surgery

Minimally invasive coronary artery bypass grafting (CABG) is a new technique developed in recent years apart from the conventional method. Our first objective is to compare the postoperative early outcomes of conventional and minimally invasive multivessel (MIM) CABG methods, and second objective is to compare perioperative differences between two surgical techniques. This retrospective, comparative study was conducted at a university hospital with 100 patients, who underwent CABG surgery from November, 1 2019 to June, 1 2020. The data of 50 patients, who underwent MIM CABG (Group M), was certain. Among the patients operated with the conventional method (Group C), 50 patients were randomly selected from the same time period. Examination of early postoperative outcomes revealed that Group C had significantly higher intensive care unit (ICU) stay (p=0.013), significantly higher mechanical ventilation time in ICU (p<0.001), and significantly higher isolated systolic blood pressure (p=0.013). Examination of perioperative variables revealed that Group C had significantly shorter duration of surgery (p<0.001), significantly shorter aortic cross-clamp time (p<0.001), significantly shorter cardiopulmonary bypass (CPB) time (p<0.001), significantly lesser graft numbers (p<0.001), significantly lesser left internal mammary artery use (p<0.05), and significantly lesser inotropic support after CPB was discontinued (p<0.05). In the light of these results, MIM CABG was associated with enhanced postoperative early outcomes with prolonged surgery time compared to conventional method.

Current status of minimally invasive, robotic and hybrid coronary artery bypass surgery

2018 ◽  
pp. 53-72
Author(s):  
Stephanie Mick ◽  
Suresh Keshavamurthy ◽  
Johannes Bonatti
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Current Status ◽  
Off Pump ◽  
Internal Mammary ◽  
Artery Disease

While coronary artery bypass graft (CABG) remains the gold standard in the treatment of multivessel coronary artery disease, it remains quite invasive. Techniques and evolving technologies of minimally invasive (including hybrid and robotic) approaches to coronary revascularization are reviewed in this chapter with a summary of the available supporting literature. Minimally invasive direct coronary bypass (MIDCAB) surgery uses an anterior, medially placed, mini-thoracotomy incision for both direct-vision left internal mammary (LIMA) harvest and creation of an anastomosis of the LIMA to a coronary artery in off-pump fashion. As in standard CABG, all patients should undergo a complete preoperative work-up, and body mass index and body habitus are to be noted. Obesity is considered a relative contraindication for MIDCAB as it may predispose to wound infection; this concern is primarily due to tissue necrosis caused by pressure on the wound edges by the retractor during LIMA harvest.

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