Tailoring Minimal Invasive Coronary Bypass to the Patient

Background Median sternotomy is the gold standard incision for most cardiac operations. However, with the advent of minimal invasive surgery, a new approach emerged in cardiac surgery named mini-sternotomy and has been successfully used to perform a variety of operations. The aim of this paper is to present our experience of using mini-sternotomy to harvest the left internal mammary artery (LIMA) for off-pump revascularization of the left anterior descending artery (LAD) Methodology Over a 2-year period (October 2012-October 2014), 100 patients underwent coronary artery bypass grafting (CABG) via conventional median sternotomy (CMS) (n=80) and mini-sternotomy (MS) (n=20). The 2 groups were compared regarding length and difficulty of surgery, postoperative pain and respiratory function, stay in the intensive care unit (ICU), wound infection, shoulder stability and other variables. Results One patient (5%) with LMS was converted into CMS due to inadequate exposure. The blood loss was less in LMS patients. Lung atelectasis and pleural effusions were less in group 2. A higher PaO2, lower PaCO2 and a shorter assisted-ventilation time were observed in LMS group. Early postoperative pain score & analgesic requirements were less in LMS patients and their hospital stay was shorter (4-5 days) than CMS. Moreover, LMS patients could return to their jobs and drove cars earlier than group 2 patients. There were 9 deaths (11.3%) in CMS group vs. one death (5%) in LMS group; however, this difference was not statistically significant (p˂0.05) Conclusions This study shows that off-pump coronary surgery through mini-sternotomy incision is feasible and safe.

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CAO 106 Normal and abnormal flow by Doppler Ultrasound of the Left Internal Mammary Artery Grafted to the Left Anterior Descending Artery done by Minimal Invasive Coronary Bypass Surgery

Ultrasound in Medicine & Biology ◽

10.1016/s0301-5629(97)80344-4 ◽

1997 ◽

Vol 23 ◽

pp. S4

Author(s):

J. Cors ◽

C. Schulte ◽

F. Varcla ◽

A. Machain ◽

E. Weinschclbaum

Keyword(s):

Doppler Ultrasound ◽

Bypass Surgery ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Coronary Bypass ◽

Minimal Invasive ◽

Coronary Bypass Surgery ◽

Left Anterior Descending Artery ◽

Internal Mammary

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Nonrobotic Total Endoscopic Coronary Artery Bypass Grafting

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000554 ◽

2018 ◽

Vol 13 (5) ◽

pp. 344-348 ◽

Cited By ~ 1

Author(s):

Hagen Gorki ◽

Jun Liu ◽

Marius Sabau ◽

Guenther Albrecht ◽

Andreas Liebold

Keyword(s):

Coronary Artery ◽

Internal Mammary Artery ◽

Left Internal Mammary Artery ◽

Artery Bypass ◽

Coronary Bypass ◽

Minimal Invasive ◽

Bypass Grafting ◽

Coronary Bypass Grafting ◽

Left Anterior Descending Artery ◽

Internal Mammary

Objective At present, minimal invasive direct coronary artery grafting is the least invasive nonrobotic surgical approach to revascularize the left anterior descending artery with the left internal mammary artery. Total endoscopic coronary bypass grafting is performed with the help of a telemanipulator (“robot”). A prospective proof-of-concept study was initiated to investigate a nonrobotic total endoscopic coronary bypass grafting approach. Methods Twenty patients with significant left anterior descending artery or left main stem lesion were operated on via three or four left thoracic access ports. Under exclusive endoscopic vision, the left internal mammary artery was harvested and anastomosed to the left anterior descending artery manually. Cardiopulmonary bypass and cardioplegic arrest were planned in all cases. Results In 10 patients, the operation was completed successfully as nonrobotic total endoscopic coronary bypass grafting. Reasons for conversions to minimal invasive direct coronary artery grafting or conventional sternotomy were dense pleural adhesions (3 patients), bleeding of the anastomosis (3), diffuse bleeding during left internal mammary artery harvesting (2), identification problems of the target artery (1), or left internal mammary artery failure (1). Postoperative angiography in five primarily successful nonrobotic total endoscopic coronary bypass grafting patients showed patent anastomoses in four cases. One patient was reoperated on for early anastomotic failure in a 1.0-mm target vessel. Until now, a percutaneous coronary intervention of remaining lesions as staged hybrid procedure was performed in three patients (2 nonrobotic total endoscopic coronary bypass grafting, 1 minimal invasive direct coronary artery grafting). Conclusions With a thoroughly surveyed learning curve, nonrobotic total endoscopic coronary bypass grafting procedure could become an alternative to other available treatment options; however, the value of the procedure has to be further investigated.

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Minimally invasive direct coronary artery bypass

State of the Art Surgical Coronary Revascularization ◽

10.1093/med/9780198758785.003.0060 ◽

2021 ◽

pp. 349-352

Author(s):

Volkmar Falk ◽

Sebastian Holinski

Keyword(s):

Coronary Artery ◽

Minimally Invasive ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Coronary Bypass ◽

Minimal Invasive ◽

Beating Heart ◽

Alternative Route ◽

Two Measures ◽

Mini Thoracotomy

There are different minimal invasive approaches of coronary bypass surgery. Avoiding sternotomy and gaining access to the heart via an alternative route is one strategy. Another is to avoid cardiopulmonary bypass. Combining these two measures defines the classical minimally invasive direct coronary artery bypass (MIDCAB) procedure. While multiple grafts can be placed through a limited mini-thoracotomy on the beating heart, the classic MIDCAB procedure is usually limited to grafting of the left internal thoracic artery to the left anterior descending artery.

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Donor transmitted anterior myocardial ischaemia in a teenager: how to proceed?

New Emirates Medical Journal ◽

10.2174/0250688202666210303122918 ◽

2021 ◽

Vol 02 ◽

Author(s):

Laszlo Göbölös ◽

Maurice Hogan ◽

Mosaad El-Banna ◽

Feras Bader ◽

Emin Murat Tuzcu ◽

...

Keyword(s):

Coronary Artery ◽

Heart Transplantation ◽

Left Internal Mammary Artery ◽

Artery Bypass ◽

Coronary Bypass ◽

Anterior Wall ◽

Minimal Invasive ◽

Orthotopic Heart Transplantation ◽

Limiting Factor ◽

Increased Risk

Background: Heart transplantation remains the treatment of choice for end-stage heart failure patients, owing to the associated dual improvements in quality of life, and prognosis. The discrepancy between higher demand and supply of donor organs is the limiting factor, and is established universally. Increasing consideration of donor population up to 65 years of age and marginal donor hearts has helped to facilitate the availability of potential grafts. However, grafts from older donors carry the mid-term increased risk of coronary allograft vasculopathy, including donor transmitted coronary disease. Case report: A 15-year-old female underwent orthotopic heart transplantation for non-ischaemic cardiomyopathy, the donor was a 44-year-old male. The recipient developed anterior wall ischaemia within a year requiring coronary angioplasty and stent implantation to treat the severe obstruction in the left anterior descending coronary artery. However, two months later, the patient was readmitted with in-stent restenosis. Therefore, to optimally revascularise the left anterior descending coronary artery, and minimise risks associated with resternotomy, a minimally invasive direct coronary artery bypass grafting of the left internal mammary artery to left anterior descending artery was performed. Conclusion: Surgical revascularisation in generalised CAV is an inadequate option; repeat HTx is the treatment of choice, albeit given its morbidity should be reserved for a highly selected patient population. In localised coronary lesions, conventional coronary bypass surgery may be a feasible choice in selected patients with LAD lesions. Minimal invasive techniques, such as MIDCAB rather than robotic techniques, would be preferable for ease of approach and to limit the surgical re-do trauma.

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