scholarly journals Left Internal Mammary Artery to Left Anterior Descending Artery. An Alternative for old, High-Risk, Multivessel, Coronary Artery Disease Patients and an Approach for Hybrid Revascularization

2022 ◽  
Vol 5 (1) ◽  
pp. 01-03
Author(s):  
Federico Benetti ◽  
Jessica Gonzalez ◽  
Natalia Scialacomo
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Minimally Invasive ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Robotic Technology ◽  
Off Pump ◽  
Internal Mammary ◽  
Hybrid Revascularization ◽  
Artery Disease

In 1997, the first ambulatory off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) anastomosis was performed via xiphoid approach, an intervention known today as the MINI-OPCAB operation. This operation has been performed in more than 150 patients around the world for the management of single and multiple vessel coronary artery disease, and 70 of those cases underwent the procedure in our Foundation from 1997 to 2021, showing no operative mortality or reintervention rates, low conversion rates, early hospital discharge, and 100% graft patency at the follow-ups. The minimally invasive direct coronary artery bypass (MIDCAB) procedure was introduced in 1994 by Benetti from Argentina, and was developed based on our previous experience performing off-pump coronary surgery by manipulating the ascending aorta through a left-sided small thoracotomy. Although it represents one of the most common minimally invasive procedures done worldwide, the original technique is not easy to reproduce, and in most cases the pleura is opened, which increases patients pain, morbidity, hospital length of stay, and hinders the realization of immediate hybrid revascularization after the procedure. The latest minimally invasive approaches for CABG include robotic-assisted procedures, in which the IMAs are harvested using robotic technology or the whole procedure is done using robotic technology. This approach has shown adequate short-term clinical results, however, there are no studies available reporting the procedure’s long-term results. Conclusion: The MINI-OPCAB operation is a friendly approach to perform Minimally Invasive Coronary Bypass Surgery in old, high-risk, multivessel coronary artery disease patients, and it represents a good intervention alternative for the majority of cardiac surgeons and cardiac specialized centers. We also consider this approach as ideal for patients who further require Hybrid Revascularization; however, more experience is needed to validate this initials results.

scholarly journals Minimally Invasive Coronary Bypass Grafting as a Standard Approach for Myocardial Revascularization

2020 ◽  
pp. 9-14
Author(s):  
O. D. Babliak ◽  
V. M. Demianenko ◽  
D. Y. Babliak ◽  
A. I. Marchenko ◽  
E. A. Melnyk ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Minimally Invasive ◽  
Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Myocardial Revascularization ◽  
Bypass Grafting ◽  
Multivessel Coronary Artery Disease ◽  
Internal Mammary ◽  
Artery Disease

  Background. Minimally invasive cardiac surgery is becoming more widespread. The aim of the study was to evaluate the outcomes in 343 consecutive patients with isolated multivessel coronary artery disease who underwent minimally invasive coronary revascularization. Materials and methods. From July 2017 to December 2019 we performed total coronary revascularization via left anterior minithoracotomy (TCRAT) in 343 consecutive patients with isolated multivessel coronary artery disease. In 83 (24.2%) of them we performed multiarterial revascularization using left internal mammary artery (LIMA) and T-shunt with left radial artery or right internal mammary artery (RIMA). Cardiopulmonary bypass (CPB), aortic cross-clamping and blood cardioplegia were used in all patients. The patients were divided into two groups, uniarterial and multiarterial, to compare and analyze perioperative parameters. Results. No cases of postoperative myocardial infarction, surgically induced infection, or conversion to sternotomy were observed in any of the study groups. Total perioperative mortality was 0.58% (2 patients). Total operation time (290.6±48 [205; 495] versus 259.4±53.3 [165; 590], p=0.0001) and aortic cross-clamping time (81.6±18.7 [40; 122] versus 67±18 [35; 146], p<0.0001) were longer in patients with multiarterial revascularization compared to those with uniarterial revascularization. The patient’s mean age in the multiarterial group was 7.4 years less than in the uniarterial group. The mean hospital stay was 0.5 days shorter in the multiarterial group. Conclusions. The technique of minimally invasive coronary artery bypass grafting via left anterior thoracotomy avoids median sternotomy in 97.7% of patients. Both strategies for minimally invasive myocardial revascularization (multiarterial and uniarterial) are safe and effective with comparable perioperative outcomes and a total mortality of 0.58%.

scholarly journals Development of Robotic Enhanced Endoscopic Surgery for the Treatment of Coronary Artery Disease

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Utz Kappert ◽  
Jens Schneider ◽  
Romuald Cichon ◽  
Vassilios Gulielmos ◽  
Sems-Malte Tugtekin ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Internal Mammary Artery ◽  
Median Sternotomy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Surgical Tool ◽  
Internal Mammary ◽  
Artery Disease

Background The introduction of robotic enhanced surgery demanded stepwise development of performed procedures on the basis of growing experience of the operating team. Methods and Results Between May 1999 and January 2001, this new wrist-enhanced instrumentation was used in 201 patients (156 men and 45 women, median age 64±10.5 years, left ventricular ejection fraction 68±12.4%). During the development of robotic enhanced CABG, the patients were divided into 3 groups. Group A (n=156) consisted of patients in whom the robotic system was used to harvesting the left or right internal mammary artery, or both, whereas the anastomoses were performed directly through a small chest incision. In group B (n=37), the harvest of the internal mammary arteries and the coronary anastomoses were performed totally endoscopically. In a third early group C, patient (n=8) were treated with robotic enhanced CABG via a median sternotomy already preoperatively planned, whereas gradual step-by-step application of robotic instrumentation and its feasibility were assessed. The survival rate was 99.4%. One patient (0.6%) died due to pneumonia on postoperative day 16. Conversion rate to median sternotomy was 5%. The left and right internal mammary artery conduits could be successfully harvested in 98% and 100%, respectively. The time of dissection of the left internal mammary artery could be significantly reduced alone by increasing experience. All patients were discharged from the hospital after a mean of 7 days. In 9 patients (4.5%), bleeding required reexploration. Conclusions The introduction of this new surgical tool enables the development of new endoscopic procedures. Our results gained during the development of robotic enhanced CABG motivate us to establish a set standard for the totally endoscopic treatment of patients with 1-vessel coronary artery disease.

scholarly journals Minimally invasive off pump CABG technique using "LIMA to LAD" first in staged hybrid approach for complex Coronary artery disease

2015 ◽  
Vol 10 (S1) ◽  
Author(s):  
Lalit Mohan Joshi ◽  
Bhuwan Chandra Tewari ◽  
Sudarshan Kumar Vijay ◽  
Subhash Singh Rajput ◽  
Dhramendra Kumar Srivastava ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Minimally Invasive ◽  
Hybrid Approach ◽  
Off Pump ◽  
Pump Cabg ◽  
Artery Disease
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