Minimal invasive coronary bypass surgery the robotic total endoscopic approach

The aim of this paper is to present the latest recommendations for practitioners for preoperative preparation, surgical procedures and postoperative treatment in patients with myocardial revascularization using robotic total endoscopic coronary artery bypass grafting (CARG), which is applied as daily clinical routine practice at the Heart and Vascular Institute, Cleveland Clinic Abu Dhabi. Many patients indicated for coronary bypass surgery may be candidates for robotic total endoscopic CARG. The paper illustrates eligibility criteria of this procedure, preoperative assessment and preparation principles, peripheral access for cardiopulmonary bypass and port insertion, then graft harvesting procedure, initiation of cardiopulmonary bypass and application of endoaortic clamping, identification and exposure of the target vessels, anastomosis procedure and postoperative care in this group of patients.

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Transient liver dysfunction increases surgical site infections after coronary surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318793305 ◽

2018 ◽

Vol 26 (6) ◽

pp. 439-445 ◽

Cited By ~ 3

Author(s):

Rakan I Nazer ◽

Khalid A Alburikan ◽

Anhar Ullah ◽

Ali M Albarrati ◽

Mazen Hassanain

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Liver Dysfunction ◽

Bypass Surgery ◽

Artery Bypass ◽

Coronary Bypass ◽

Surgical Site Infections ◽

Perioperative Period ◽

Coronary Bypass Surgery ◽

Cardiac Procedures

Background Surgical site infections can have a significant impact on cardiac surgical outcome. The liver plays an important role in infection prevention. This study aimed to retrospectively determine whether transient postoperative liver dysfunction after coronary bypass surgery increased surgical site infections. Methods A modified version of the Schindl scoring scale for liver dysfunction was adapted to objectively quantify transient liver dysfunction in the first 7 days after on-pump coronary artery bypass grafting. A retrospective analysis of clinical outcomes at 30 months postoperatively was performed on data of 575 patients who underwent coronary artery bypass between 2014 and 2016. The patients were categorized into a liver dysfunction group (Schindl score ≥ 4) and a non-liver dysfunction group (Schindl score < 4). Results The liver dysfunction group (47.3%) had significantly more patients who were obese, current smokers, and had diabetes, renal impairment, and peripheral vascular disease. Surgical site infections occurred predominantly in the liver dysfunction group (12.1% vs. 0.3%, p < 0.001). The independent predictors of surgical site infection were liver dysfunction, body mass index > 30 kg m−2, and coronary bypass surgery combined with other cardiac procedures. Conclusions Surgical wound infections can be precipitated by multiple factors before, during, and after coronary bypass surgery. Transient liver dysfunction in the perioperative period is associated with an increased rate of surgical infections even after adjusting for known risk factors. Considering this factor as well as other known risks may help to identify and stratify patients with a potentially higher risk of surgical site infections.

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Predictors for New Native-Vessel Occlusion in Patients with Prior Coronary Bypass Surgery: A Single-Center Retrospective Research

Cardiology Research and Practice ◽

10.1155/2019/6857232 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Ze Zheng ◽

Zi chao Cheng ◽

Shao ping Wang ◽

Shi ying Li ◽

Jian Wang ◽

...

Keyword(s):

Bypass Surgery ◽

Artery Bypass ◽

Coronary Bypass ◽

Postoperative Management ◽

Careful Consideration ◽

Coronary Bypass Surgery ◽

Vessel Occlusion ◽

Total Occlusion ◽

Reduced Ejection Fraction ◽

Occlusion Rate

Objectives. Chronic total occlusion (CTO) is prevalent in patients with prior coronary artery bypass grafting (CABG). However, data available concerning the prevalence of new-onset CTO of native vessels in patients with prior CABG is limited. Therefore, the objective of the study is to determine predictors for new native-vessel occlusion in patients with prior coronary bypass surgery. Methods. 354 patients with prior CABG receiving follow-up angiography are selected and analyzed in the present study, with clinical and angiographic variables being analyzed by logistic regression to determine the predictors of new native-vessel occlusion. Results. The overall new occlusion rate was 35.59%, with multiple CTOs (42.06%) being the most prevalent (LAD 24.60% and RCA 18.25%, respectively). Additionally, current smoking (OR: 2.67; 95% CI: 2.60 to 2.74; p=0.01), reduced ejection fraction (OR: 1.76; 95% CI: 1.04 to 2.97; p=0.04), severe stenosis (OR: 3.65; 95% CI: 2.55 to 5.24; p=0.01), and diabetes mellitus (OR: 1.86; 95% CI: 1.34 to 2.97; p=0.04) serve as the independent predictors for new native-vessel occlusion. Conclusion. As to high incidence of postoperative CTO, appropriate revascularization strategies and postoperative management should be taken into careful consideration.

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Heparin-coated Cardiopulmonary Bypass Circuits in Coronary Bypass Surgery

Artificial Organs ◽

10.1111/j.1525-1594.1996.tb04573.x ◽

1996 ◽

Vol 20 (8) ◽

pp. 936-940 ◽

Cited By ~ 10

Author(s):

Hitoshi Horimoto ◽

Keiichiro Kondo ◽

Kunio Asada ◽

Shinjiro Sasaki

Keyword(s):

Cardiopulmonary Bypass ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery

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Surgical Steps toward Complete Revascularization in Off-Pump Coronary Bypass

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000302 ◽

2002 ◽

Vol 10 (3) ◽

pp. 201-205 ◽

Cited By ~ 2

Author(s):

Kit V Arom ◽

Robert W Emery ◽

Thomas F Flavin ◽

Vibhu R Kshettry ◽

Patricia Janey

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Revascularization ◽

Artery Bypass ◽

Myocardial Revascularization ◽

Surgical Techniques ◽

Coronary Bypass ◽

Patient Characteristics ◽

Complete Revascularization ◽

Anesthetic Techniques ◽

Off Pump

Surgical techniques aimed at complete myocardial revascularization without the use of cardiopulmonary bypass are described. Between January 1998 and June 2000, coronary artery bypass was performed in 3,003 patients; an off-pump technique was used in 676 and cardiopulmonary bypass was employed in 2,327. Patient characteristics, demography, and preoperative risk factors of the two groups were compared retrospectively, and differences in operative variables and postoperative outcomes were analyzed. Using a commercially available suction stabilization device and the surgical and anesthetic techniques described herein, off-pump coronary revascularization was accomplished with results comparable to the on-pump approach.

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Comparison of two doses of aprotinin in patients receiving aspirin before coronary bypass surgery

Perfusion ◽

10.1177/026765910001500204 ◽

2000 ◽

Vol 15 (2) ◽

pp. 105-110 ◽

Cited By ~ 11

Author(s):

Sergio V Moran ◽

Guillermo Lema ◽

Jessica Medel ◽

Manuel J Irarrazaval ◽

Ricardo Zalaquett ◽

...

Keyword(s):

Blood Loss ◽

Bypass Surgery ◽

Artery Bypass ◽

Coronary Bypass ◽

Drug Efficacy ◽

Coronary Bypass Surgery ◽

Postoperative Blood Loss ◽

Treatment Groups ◽

Group I ◽

Transfusion Requirements

This study was designed to evaluate efficacy and tolerability of two different doses of aprotinin in patients receiving aspirin before undergoing coronary artery bypass grafting. Forty-two patients were randomized to receive either placebo (group I), or aprotinin in doses of 4 000 000 KIU (group II) or 6 000 000 KIU (group III). Drug efficacy was determined by measuring postoperative blood loss and transfusion of blood products. Both doses were effective in reducing blood loss and transfusion requirements. Blood loss through thoracotomy drainage was 450 ± 224, 182 ± 144, 142 ± 98 ml, respectively, for control and treatment groups II and III ( p = 0.0001). The numbers of patients with blood transfusions were seven (50%), two (17%) and two (17%) for group I and treatment groups II and III, respectively ( p = 0.10). Tolerability was excellent and complications few and reversible. In conclusion, high and medium doses of aprotinin were well tolerated and reduced bleeding and transfusion requirements in patients submitted to coronary bypass surgery under the effects of aspirin.

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Concomitant Carotid Endarterectomy and Coronary Bypass Surgery: Should Cardiopulmonary Bypass Be Used for the Carotid Procedure?

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2001.tb01220.x ◽

2008 ◽

Vol 17 (1) ◽

pp. 51-59 ◽

Cited By ~ 14

Author(s):

Massimo Bonacchi ◽

Edvin Prifti ◽

Giacomo Frati ◽

Marzia Leacche ◽

Gabriele Giunti ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Carotid Endarterectomy ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery

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Is Carotid Artery Stenting an Alternative to Simultaneous Carotid Endarterectomy Performed for Carotid Artery Stenosis in Patients Undergoing Isolated Coronary Bypass Surgery?

The Heart Surgery Forum ◽

10.1532/hsf.1290 ◽

2015 ◽

Vol 18 (5) ◽

pp. 211 ◽

Cited By ~ 1

Author(s):

Hüseyin Şaşkın ◽

Cagri Duzyol ◽

Kazım Serhan Ozcan ◽

Rezan Aksoy ◽

Mustafa Idiz

Keyword(s):

Myocardial Infarction ◽

Cardiopulmonary Bypass ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenting ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery ◽

Group 2 ◽

Group 1

Background: Treatment method in patients with coronary artery disease undergoing coronary bypass surgery with accompanying carotid artery disease is still a hot topic among clinicians. This study is designed to investigate if there is an effect on myocardial infarction, cerebrovascular events and mortality during postoperative period of simultaneous carotid endarterectomy with coronary bypass surgery compared to staged carotid artery stenting before coronary bypass surgery. Methods: 102 patients (79 male, 23 female) who underwent simultaneous carotid endarterectomy with coronary bypass surgery or staged carotid artery stenting with coronary bypass surgery in the same center with the same surgical team were divided into 2 groups and retrospectively reviewed. Group 1 (n = 71) had coronary artery bypass surgery under general anesthesia with carotid endarterectomy followed by cardiopulmonary bypass with heart team decision. Again with heart team decision, Group 2 (n=31), patients at high-risk for carotid endarterectomy (serious cardiac disease, severe chronic obstructive pulmonary disease, superiorly located lesions), received carotid artery stents in the interventional radiology department and a month later, coronary bypass surgery was performed with cardiopulmonary bypass under elective conditions. Results: Median of patient age was 67.5 (45-83) years. Twenty-two patients (31%) in Group 1 and 19 patients (56.3%) in Group 2 had neurological symptoms, which was statistically significant (P = .004). During the early postoperative term, three patients (4.2%) in Group 1 and two patients (6.5%) in Group 2 died (P = .64). Five patients (7.0%) in Group 1 and two patients (6.5%) in Group 2 developed neurological symptoms during the early postoperative term (P > .05). Likewise, two patients (2.8%) in Group 1 and five patients (16.1%) in Group 2 developed myocardial infarction following carotid intervention (P = .03). Conclusions: In patients with significant carotid artery stenosis undergoing coronary bypass surgery with cardiopulmonary bypass, in comparison to simultaneous carotid endarterectomy with coronary bypass technique and carotid artery stenting followed with coronary bypass technique showed no difference in combined endpoint (postoperative myocardial infarction, neurological events, and mortality). With proper tools and according to the decisions made by heart teams, both management strategies can be safely performed.

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Target Vessel Detection by Epicardial Ultrasound in Off-Pump Coronary Bypass Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182a75e95 ◽

2013 ◽

Vol 8 (4) ◽

pp. 249-252 ◽

Cited By ~ 2

Author(s):

Masato Hayakawa ◽

Tohru Asai ◽

Takeshi Kinoshita ◽

Tomoaki Suzuki ◽

Shoichiro Shiraishi

Keyword(s):

Cardiopulmonary Bypass ◽

Coronary Arteries ◽

High Frequency ◽

Bypass Surgery ◽

Operation Time ◽

Coronary Bypass ◽

Postoperative Outcome ◽

Coronary Bypass Surgery ◽

Off Pump ◽

The Impact

Objective The detection of embedded coronary arteries is difficult especially in off-pump coronary bypass surgery. From June 2010, we introduced high-frequency epicardial ultrasound (ECUS) to assess and evaluate embedded arteries during off-pump coronary bypass surgery. Methods Between June 2010 and June 2011, a total of 89 consecutive patients underwent isolated coronary bypass surgery at our institution. The patients consisted of 72 men and 17 women with a mean age of 67.9 years. We routinely use the VeriQC system (MediStim, Oslo, Norway) to detect the target vessels in the operation. The patients were assigned to one of two groups, depending on whether ECUS was used in the operation (n = 10, ECUS group) or not (n = 79, non-ECUS group). We analyzed the impact of introducing the ECUS in terms of operative outcome. Results All patients underwent revascularization using the off-pump technique without emergent conversion to cardiopulmonary bypass during surgery. The total number of distal anastomoses was 299, and 12 target vessels could not be identified either visually or on palpation. Thus, the frequency of the embedded coronary arteries was 4.01% (12/299 cases). The preoperative profiles of the two groups were not significantly different. Operation time was significantly longer in the ECUS group ( P = 0.02). There were no significant differences in postoperative outcome between the two groups. Conclusions In the present study, in which the target coronary arteries could not be detected either visually or on palpation in 12 (4.01%) of 299 cases, the use of high-frequency ECUS allowed all patients to undergo off-pump coronary bypass surgery without conversion to cardiopulmonary bypass during the operation. High-frequency ECUS is therefore useful in off-pump coronary bypass surgery.

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