scholarly journals Off Pump Complete Revascularization Through Left Lateral Thoracotomy (ThoraCAB): NICVD Experience

1970 ◽  
Vol 3 (1) ◽  
pp. 33-36
Author(s):  
MK Hassan ◽  
MF Maruf ◽  
F Ahmed ◽  
ZH Khan ◽  
MR Islam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Respiratory Acidosis ◽  
Vascular Diseases ◽  
Complete Revascularization ◽  
Off Pump ◽  
Cardio Vascular ◽  
Lateral Thoracotomy

Background: Conventional coronary artery bypass surgery (CABG) is associated with substantial morbidity caused by cardiopulmonary bypass (CPB) and median sternotomy. Here we described an innovative technique to perform complete revascularization through a left lateral thoracotomy without CPB (ThoraCAB). Methods: From September 2005 to December 2008 a total 83 patients underwent ThoraCAB in National Institute of Cardio Vascular Diseases (NICVD). The patient is positioned with the left side elevated to 45 degree. A 6 to 8 inches long incision is made over the left 4th or 5th intercostal space from just medial to the nipple to the anterior axillary line. The left internal mammary artery (LIMA) is harvested as a pedicle graft under vision. Distal coronary anastomosis is completed first on the beating heart using a stabilizer, followed by proximal anastomoses on the descending aorta. Peroperative and postoperative complication the arrhythmia hypotension wound infection death was observed. Results: Complete revascularization was achieved in all patients. The number of grafts averaged 2.18±1.08 per patients. One patient died (1.2%) due to severe respiratory acidosis. One patient (1.2%) was converted to CPB due to arrhythmia. No strokes were observed. Of these patients, 7.2% developed new onset postoperative atrial fibrillation. Conclusion: ThoraCAB has been feasible in the vast majority of the patients requiring CABG surgery. The prevalence of the post operative atrial fibrillation was low. Left lateral thoracotomy offers an attractive and effective alteration to Off Pump median sternotomy. Key words: ThoraCAB; Lateral thoracotomy; CABG DOI: 10.3329/cardio.v3i1.6424Cardiovasc. j. 2010; 3(1): 33-36

scholarly journals New-Onset Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting: Predictors and In-hospital Complications

2020 ◽  
Author(s):  
Hao Xu ◽  
Guangpu Fan ◽  
Yu Chen
Keyword(s):  
Atrial Fibrillation ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Bypass Grafting ◽  
Peripheral Vascular ◽  
Off Pump ◽  
Mechanical Ventilation Time ◽  
Pump Coronary Artery Bypass ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Objective To explore risk factors and in-hospital complications of new-onset atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB). Methods In this study of 1344 patients who underwent isolated OPCAB from 2012 to 2015, patients were divided into AF and non-AF group according to whether new-onset postoperative AF occurred. Results The incidence of new-onset AF after OPCAB was 28.57%, mainly appeared within the first 4 days after surgery. After binary logistic regression analysis, age, peripheral vascular disease, median-sternotomy OPCAB, mechanical ventilation time, IABP were independent predictors of AF( p <0.001,OR 1.039,95%CI 1.023-1.055; p =0.007,OR 2.450,95%CI 1.282-4.684; p =0.044,OR 0.589,95%CI 0.351-0.987; p =0.013,OR 1.006,95%CI 1.001-1.011; p =0.007,OR 3.001,95%CI 1.356-6.642, respectively). Patients with AF have a significant higher risk of reoperation, re-entry into ICU, re-intubation, postoperative myocardial infarction, renal failure, and death ( p =0.013, p =0.015, p <0.001, p =0.037, p <0.001, p <0.001, respectively), also a longer re-ICU time ( p =0.014). Conclusion Advanced age, peripheral vascular disease, median-sternotomy OPCAB, mechanical ventilation time, IABP were independent predictors for new-onset AF after OPCAB. Postoperative AF was clearly associated with more in-hospital complications.

scholarly journals Minimal sternotomy surgery in comparison to standard sternotomy in the coronary bypass Surgery

2019 ◽  
Vol 15 (1) ◽  
pp. 75-78
Author(s):  
Jabbar J. Altae
Keyword(s):  
Postoperative Pain ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Coronary Bypass ◽  
Assisted Ventilation ◽  
Minimal Invasive ◽  
Off Pump ◽  
Internal Mammary ◽  
Group 2

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.

Circulatory support for OPCAB procedures

Perfusion ◽  
2002 ◽  
Vol 17 (4) ◽  
pp. 305-312 ◽  
Author(s):  
Xavier M Mueller ◽  
Ludwig K von Segesser
Keyword(s):  
Artery Bypass ◽  
Median Sternotomy ◽  
Circulatory Support ◽  
Haemodynamic Instability ◽  
Complete Revascularization ◽  
Experimental Conditions ◽  
Off Pump ◽  
Priming Volume ◽  
Pump Coronary Artery Bypass ◽  
The Right

During off-pump coronary artery bypass grafting (OPCAB) which allows complete revascularization through a median sternotomy, revascularization of the lateral and posterior walls requires the verticalization of the heart, which may cause haemodynamic disturbance. This concern has stimulated the development of circulatory support with mini-pumps. Initially, these pumps were designed for the right side of the heart, which was found to be the main contributor to haemodynamic instability under experimental conditions. The three types of mini-pumps that have been developed so far—two for the right side of the heart and one for both sides—are reviewed as well as a new concept of integrated cardiopulmonary bypass (CPB) circuit with reduced surface and priming volume. However, with increasing experience and improved methods of exposition, OPCAB has become a procedure that can be performed without support in the majority of the cases. Nevertheless, the concept of miniaturization and the possibility to insert these devices through a peripheral access has opened the way to new indications, mainly short-term circulatory support for acute heart failure. This development is welcome in a field where available devices are invasive and plagued with a heavy morbidity.

First Turkish Experiences of Assisted Beating-Heart Coronary Artery Bypass Graft with the Impella Microaxial Ventricular Assist Device�

2010 ◽  
Vol 13 (1) ◽  
pp. 60 ◽  
Author(s):  
Cenk Eray Yildiz ◽  
Murat Sayin ◽  
Halit Yerebakan ◽  
Suha Kucukaksu
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Beating Heart ◽  
Complete Revascularization ◽  
Artery Bypass Graft ◽  
Assist Device ◽  
Ventricular Assist ◽  
Off Pump

The importance of minimally invasive cardiac operations, performed off-pump, without the support of cardiopulmonary bypass (CPB), is continuously increasing. Complete revascularization of obstructed coronary arteries is needed to obtain a better long-term outcome. Insertion into the left ventricle of an efficient microaxial pump can be useful when targeting an important coronary artery located at posterior wall of the heart in a patient with hemodynamic deficiency. The use of such a device can enable surgeons to avoid conversion from a preplanned off-pump strategy to traditional on-pump coronary bypass surgery. The Impella Microaxial Ventricular Assist Device (VAD) (Abiomed, Aachen, Germany) is a miniature pump with a 7-mm catheter and a flow rate of approximately 2.5-5 L/min. This device can enable cardiovascular surgery to be performed without damaging the left ventricle and causing serious aortic deficiency. Therefore, in patients with serious comorbidity, complete revascularization may be performed off pump, with the heart beating, because of the hemodynamic stability provided with the support of the microaxial intracardiac pump. If required, this pump can also support the heart during the early postoperative period. We report the first assisted beating-heart coronary artery bypass graft surgery performed with the Impella Microaxial VAD in our country. The surgery was performed on 2 patients considered high risk on the basis of EUROSCORE testing.

Clinical Outcomes after Hybrid Coronary Revascularization versus Off-Pump Coronary Artery Bypass

2009 ◽  
Vol 4 (6) ◽  
pp. 299-306 ◽  
Author(s):  
Thomas A. Vassiliades ◽  
Patrick D. Kilgo ◽  
John S. Douglas ◽  
Vasilis C. Babaliaros ◽  
Peter C. Block ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Off Pump ◽  
Internal Mammary ◽  
Hybrid Coronary Revascularization ◽  
Pump Coronary Artery Bypass ◽  
Hybrid Group

Objective Hybrid coronary revascularization is offered as an alternative strategy for patients with multivessel coronary artery disease (CAD). We present our experience and provide a comparative analysis to off-pump coronary artery bypass grafting (OPCAB). Methods Ninety-one patients with multivessel CAD underwent minimally invasive left internal mammary artery to left anterior descending grafting in combination with percutaneous coronary intervention of nonleft anterior descending targets (HYBRID). The primary end point of this study was major adverse cardiac and cerebrovascular events (MACCE), defined as death, stroke, and nonfatal myocardial infarction. MACCE in the HYBRID group were compared with 4175 contemporaneously performed OPCAB operations by logistic (30-day outcomes) and Cox proportional hazards (long-term survival) regression methods. Propensity scoring was used to adjust for potential selection bias. Results The 30-day MACCE (death/stroke/nonfatal myocardial infarction) rate was 1.1% for the HYBRID group (0%/0%/1.1%) and 3.0% for the OPCAB group (1.8%/1.1%/0.5%) (odds ratio = 0.47, P = 0.48). Angiographic left internal mammary artery evaluation was obtained in 95.6% of patients (87 of 91) revealing FitzGibbon A patency in 98.0% (96 of 98). The reintervention rate at 1 year for the HYBRID group was 5.5% (5 of 91) and was limited to repeat percutaneous coronary intervention. Three-year survival was statistically similar for the two groups (hazard ratio = 0.44, P = 0.18, see Kaplan-Meier figure). Conclusions Hybrid coronary revascularization may be noninferior to OPCAB with respect to early MACCE and 3-year survival in the treatment of multivessel CAD.

MINI OPCAB Operation: Surgical Technique

2021 ◽  
Author(s):  
Federico Benetti ◽  
Natalia Scialacomo ◽  
Gustavo Mazzolino
Keyword(s):  
Surgical Technique ◽  
Large Scale ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Off Pump ◽  
Internal Mammary ◽  
Hybrid Revascularization ◽  
Pump Coronary Artery Bypass ◽  
The Right

Introduction: We describe how to perform left internal mammary artery (LIMA) bypass to the left anterior descending (LAD) artery, the so-called MINI Off-pump Coronary Artery Bypass (MINI OPCAB). Materials and Methods: We included patients with a demonstrated predominant ischemia related to the LAD territory. Of 70 patients who were operated upon at the Benetti Foundation, 10 received hybrid revascularization. Surgical Technique: The patient is prepared as for a standard coronary bypass operation through sternotomy. The sternum is opened to the 3rd or 4th intercostal space depending on the anatomy, and a retractor is put in place. The left mammary artery is generally dissected to about 8 cm and isolated without the veins. Importantly, the angle of the superior part, where the mammary artery is attached to the sternum, needs to be below 20% to avoid any potential kinking. The pericardium is cleaned to identify the area of the pulmonary artery. The pericardium is opened to the apex and towards the right to around 5 to 6 cm initially. In most cases, the area of the LAD can be seen and the potential area of the anastomosis is defined. The patient is heparinized and the LAD is occluded with 5-0 Proline. A mechanical stabilizer is put in place and the anastomosis is performed. When the bypass is finished, and before sutures are tied, the stitches of 5-0 polypropylene around the artery are released, along with the clamp of the mammary artery; the anastomosis is then tied. The mechanical stabilizer is removed, the stitches of the pericardium are released and the flow of the graft is measured, while ensuring that there is no kinking. If the flow and Pulsatility and Resistance (PR) are acceptable, the mammary is fixed with 2 stitches of 7-0 polypropylene on both sides around 1 cm from the anastomosis. The heparin is reverted with protamine and a drain is put in place, while taking care to avoid any chance of touching the mammary artery or the anastomosis. The sternum is closed with 1 or 2 wires. Results: Operative mortality in this series was 0%; one patient was converted to sternotomy off-pump (1.4%). None of the grafts were revised after measurement with a Medistim system (Medistim ASA, Oslo, Norway). Fifty five patients (79%) were extubated in the operating room The average hospitalization stay was 60 hours (SD 17, 95% CI). Sixteen patients who underwent the LIMA-to-LAD procedure were restudied, with 100% patency. At 144 months, 82% of the patients were alive and 68% were asymptomatic. Conclusion: Additional clinical experience is required to be able to reproduce this operation on a large scale and expand the MINI OPCAB operation in hybrid revascularization.

Outcomes after Off-Pump Reoperative Coronary Artery Bypass Grafting

2007 ◽  
Vol 2 (1) ◽  
pp. 29-32 ◽  
Author(s):  
Cullen D. Morris ◽  
John D. Puskas ◽  
Sorin V. Pusca ◽  
Omar M. Lattouf ◽  
William A. Cooper ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Propensity Scores ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Retrospective Chart Review ◽  
Technical Difficulty ◽  
Off Pump ◽  
Intention To Treat ◽  
Hemodynamic Deterioration

Objective Application of off-pump techniques to reoperative coronary artery bypass (redo CABG) has been limited by technical difficulty and potential for embolism of atheromatous debris from diseased grafts, resulting in myocardial infarction and rapid hemodynamic deterioration. We compared outcomes after off-pump (OPCAB) and on-pump (ONCAB) in redo CABG. Methods A retrospective chart review was performed for patients who underwent redo CABG at a single academic institution between January 1997 and December 2004. Outcomes were compared between groups based on intention to treat. Propensity scores were calculated for each patient using 23 preoperative risk factors. Logistic regression was applied for each end point as a function of group and propensity score. Results A total of 771 consecutive patients had redo CABG (639 ONCAB and 132 OPCAB); 22 patients (16.7%) were converted from OPCAB to ONCAB for hemodynamic in stability, severe adhesions, or graft injury; 7 patients (1.1%) were converted from ONCAB to OPCAB for severe aortic calcification. Propensity-matched comparison of outcomes after OPCAB versus ONCAB for redo CABG showed that OPCAB was associated with a reduction in postoperative complications, transfusion, atrial fibrillation, and length of stay. OPCAB patients received fewer grafts with similar use of left internal mammary artery conduit; conversion from OPCAB to ONCAB did not reduce the benefit of OPCAB. Conclusions OPCAB can be safely and effectively applied to reoperative CABG in selected cases.

scholarly journals Effect of preoperative atrial fibrillation on long-term results after Off Pump Coronary Artery Bypass

2021 ◽  
Vol 38 (6) ◽  
pp. 5-15
Author(s):  
Soslan T. Enginoev ◽  
Dmitriy A. Kondratiev ◽  
Gasan M. Magomedov ◽  
Tamara K. Rashidova ◽  
Bakytbek K. Kadyraliev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Results ◽  
Off Pump ◽  
Group I ◽  
Pump Coronary Artery Bypass

Objective. To study the effect of preoperative atrial fibrillation (AF) on the risk of stroke and long-term mortality after Off Pump Coronary Artery Bypass (OPCAB). Materials and methods. A retrospective analysis of the results of OPCAB in 212 patients with coronary artery disease (CAD), who were operated on from May 2009 to November 2013, was carried out. After propensity score matching, patients were divided into 2 groups: Group I 82 patients with sinus rhythm (SR) before surgery, Group II (control) 102 patients with AF before surgery. The average age of the included patients was 61 6.7 years, with 95 % CI: 6062. Fifty-four (29.3 %) patients were over 65 years of age. There were 162 men (88 %) and 22 women (12 %). The median follow-up was 93.5 (66.7102.0) months. Results. The time spent in the clinic was statistically significantly shorter in the SR group than in the AF group (10 (911) and 14 (1116) hours, respectively, p 0.001). There was no statistically significant difference in the number of perioperative myocardial infarctions (in the group with SR it occurred in 1 (1.2 %) patient, in the group with AF 2 (2 %), p = 0.7), strokes (in the group with SR 1 (1.2 %), in the group with AF 3 (2.9 %), p = 0.6), as well as a 30-day mortality (in the group with SR it was 0 %, in the group with AF 3 (2.9 %), p = 0.2). In the long-term postoperative period, there were statistically significantly fewer strokes in the group with SR than in the group with AF (in the group with SR, the 10-year stroke freedom was 88.8 %, and in the group with AF 71.8 %, p = 0.018), and also better long-term survival in the group with sinus rhythm (in the group with SR, the 10-year survival rate was 79 %, in the group with AF 63.9 %, p = 0.016). Conclusions. In the group with preoperative AF, the frequency of distant strokes and deaths is higher than in patients with sinus rhythm.

Intravascular Ultrasound: Potential Tool to Assess Coronary Anastomosis Quality

2003 ◽  
Vol 11 (2) ◽  
pp. 143-146
Author(s):  
Piergiorgio Tozzi ◽  
Antonio F Corno ◽  
Ludwig K von Segesser
Keyword(s):  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Ultrasound Images ◽  
Cross Sectional ◽  
Flow Measurements ◽  
Off Pump ◽  
The Mean ◽  
Macroscopic Examination

Coronary angiography and Doppler flow measurements are most commonly used to assess the patency of anastomoses in the operating theater. Intravascular ultrasound might be another means of monitoring the surgical procedure during coronary artery bypass. Five sheep underwent off-pump bypass of the left anterior descending coronary artery using the left internal mammary artery. The running suture was evaluated by intraoperative fluoroscopy and a coronary intravascular ultrasound probe inserted into the target artery proximal to the anastomosis. Macroscopic examination of the anastomosis was performed to validate the angiographic and intravascular ultrasound images. The diameter, cross-sectional area, and compliance of each anastomosis were calculated in systole and diastole. All anastomoses were patent without signs of stenosis. In one case, intravascular ultrasound showed an intimal flap, which was confirmed by macroscopic examination. The mean major anastomotic diameter was 4.5 ± 0.5 mm on angiography and 4.0 ± 0.5 mm on intravascular ultrasound. From the ultrasound data, the mean cross-sectional anastomotic area was calculated as 6.21 ± 0.1 mm2 in systole and 5.49 ± 0.1 mm2 in diastole, and these data were used to calculate the cross-sectional anastomosis compliance. Coronary intravascular ultrasound can visualize intima-to-intima apposition and provide reliable calculations of anastomosis compliance.

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