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Ong ZX, Wu D, Sule JA, Chang G, Sazzad F, Luo H, Hu P, Kofidis T. Minimally Invasive Coronary Artery Bypass Grafting in a Low-Risk Asian Cohort: A Propensity-Score Matched Study. Braz J Cardiovasc Surg 2024; 39:e20220421. [PMID: 39037968 PMCID: PMC11259139 DOI: 10.21470/1678-9741-2022-0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/19/2023] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION Minimally invasive coronary artery bypass grafting (MICS CABG) offers a new paradigm in coronary revascularization. This study aims to compare the outcomes of MICS CABG with those of conventional median sternotomy CABG (MS CABG) within a growing minimally invasive cardiac surgical program in Singapore. METHODS Propensity matching produced 111 patient pairs who underwent MICS CABG or MS CABG between January 2009 and February 2020 at the National University Heart Centre, Singapore. Minimally invasive direct coronary artery bypass surgery patients were matched to single- or double-graft MS CABG patients (Group 1). Multivessel MICS CABG patients were matched to MS CABG patients with equal number of grafts (Group 2). RESULTS Overall, MICS CABG patients experienced shorter postoperative length of stay (P<0.071). In Group 2, procedural duration (P<0.001) was longer among MICS CABG patients, but it did not translate to adverse postoperative events. Postoperative outcomes, including 30-day mortality, reopening for bleeding, new onset atrial fibrillation as well as neurological, pulmonary, renal, and infectious complications were comparable between MICS and MS CABG groups. CONCLUSION MICS CABG is a safe and effective approach for surgical revascularization of coronary artery disease and trends toward a reduction in hospital stay.
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Affiliation(s)
- Zhi Xian Ong
- Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
| | - Duoduo Wu
- Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore
| | - Jai Ajitchandra Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
| | - Guohao Chang
- Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
| | - Faizus Sazzad
- Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
| | - Haidong Luo
- Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
| | - Peggy Hu
- Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National
University Heart Centre, Singapore
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Weymann A, Amanov L, Beltsios E, Arjomandi Rad A, Szczechowicz M, Merzah AS, Ali-Hasan-Al-Saegh S, Schmack B, Ismail I, Popov AF, Ruhparwar A, Zubarevich A. Minimally Invasive Direct Coronary Artery Bypass Grafting: Sixteen Years of Single-Center Experience. J Clin Med 2024; 13:3338. [PMID: 38893048 PMCID: PMC11173276 DOI: 10.3390/jcm13113338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Coronary artery disease is a major cause of death globally. Minimally invasive direct coronary artery bypass (MIDCAB), using a small left anterior thoracotomy, aims to provide a less invasive alternative to traditional procedures, potentially improving patient outcomes with reduced recovery times. Methods: This retrospective, non-randomized study analyzed 310 patients who underwent MIDCAB between July 1999 and April 2022. Data were collected on demographics, clinical characteristics, operative and postoperative outcomes, and follow-up mortality and morbidity. Statistical analysis was conducted using IBM SPSS, with survival curves generated via the Kaplan-Meier method. Results: The cohort had a mean age of 63.3 ± 10.9 years, with 30.6% females. The majority of surgeries were elective (76.1%), with an average operating time of 129.7 ± 35.3 min. The median rate of intraoperative blood transfusions was 0.0 (CI 0.0-2.0) Units. The mean in-hospital stay was 8.7 ± 5.5 days, and the median ICU stay was just one day. Early postoperative complications were minimal, with a 0.64% in-hospital mortality rate. The 6-month and 1-year mortalities were 0.97%, with a 10-year survival rate of 94.3%. There were two cases of perioperative myocardial infarction and no instances of stroke or new onset dialysis. Conclusions: The MIDCAB approach demonstrates significant benefits in terms of patient recovery and long-term outcomes, offering a viable and effective alternative for patients suitable for less invasive procedures. Our results suggest that MIDCAB is a safe option with favorable survival rates, justifying its consideration in high-volume centers focused on minimally invasive techniques.
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Affiliation(s)
- Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Lukman Amanov
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Eleftherios Beltsios
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | | | - Marcin Szczechowicz
- Department of Cardiac Surgery, University Hospital Halle, 06120 Halle (Saale), Germany
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Bastian Schmack
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Issam Ismail
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Aron-Frederik Popov
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
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Salamate S, Bakhtiary F, Bayram A, Sirat S, Doss M, Ciobanu V, Monsefi N, El-Sayed Ahmad A. Comparison of Two Surgical Approaches for Coronary Artery Bypass of Left Anterior Descending Artery. J Clin Med 2024; 13:3158. [PMID: 38892869 PMCID: PMC11173335 DOI: 10.3390/jcm13113158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: The minimally invasive approach through left mini-thoracotomy is a promising alternative to the median sternotomy for coronary artery bypass. The aim of this study was to compare the short-term outcomes of patients undergoing minimally invasive coronary artery bypass (MIDCAB) with off-pump coronary artery bypass through sternotomy (OPCAB) for single-vessel disease. Methods: From January 2017 to February 2023, 377 consecutive patients aged above 18 years undergoing off-pump bypass of the left anterior descending artery (LAD) with left internal thoracic artery underwent OPCAB. Propensity score matching was then applied. Primary endpoints were in-hospital mortality and 30-day mortality. Results: Prior to matching, 30-day mortality occurred in 2 (0.7%) patients in the MIDCAB group vs. 1 (1%) patient in the OPCAP group (p = 1). Transfusion of red blood cells (RBC) was required in 9.4% and 29% of patients within the MIDCAB and the OPCAB groups, respectively (p < 0.001). Median intensive care stay (ICU) was 1 [1-2] day in the MIDCAB group, vs. 2 [1-3] in the OPCAB (p < 0.001). In the matched cohort, 10% of MIDCAB patients received RBCs vs. 27.5% of OPCAB patients (p = 0.006). Median ICU stay was significantly lower in the MIDCAB group, 1 [1-2] vs. 2 [1-3] days. Conclusions: MIDCAB is as safe and effective as OPCAB for single coronary artery bypass of the LAD with the LITA in select patients. It is associated with a decreased ICU stay and lower transfusion rates when compared with OPCAB.
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Affiliation(s)
- Saad Salamate
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (F.B.); (V.C.); (N.M.); (A.E.-S.A.)
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (F.B.); (V.C.); (N.M.); (A.E.-S.A.)
| | - Ali Bayram
- Division of Cardiac Surgery, Heart Centre Siegburg, 53721 Siegburg, Germany; (A.B.); (S.S.); (M.D.)
| | - Sami Sirat
- Division of Cardiac Surgery, Heart Centre Siegburg, 53721 Siegburg, Germany; (A.B.); (S.S.); (M.D.)
| | - Mirko Doss
- Division of Cardiac Surgery, Heart Centre Siegburg, 53721 Siegburg, Germany; (A.B.); (S.S.); (M.D.)
| | - Veaceslav Ciobanu
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (F.B.); (V.C.); (N.M.); (A.E.-S.A.)
| | - Nadejda Monsefi
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (F.B.); (V.C.); (N.M.); (A.E.-S.A.)
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (F.B.); (V.C.); (N.M.); (A.E.-S.A.)
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Sharaf M, Zittermann A, Sunavsky J, Gilis-Januszewski T, Rojas SV, Götte J, Opacic D, Radakovic D, El-Hachem G, Razumov A, Renner A, Gummert JF, Deutsch MA. Early and late outcomes after minimally invasive direct coronary artery bypass vs. full sternotomy off-pump coronary artery bypass grafting. Front Cardiovasc Med 2024; 11:1298466. [PMID: 38450373 PMCID: PMC10914960 DOI: 10.3389/fcvm.2024.1298466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Objectives Minimally-invasive direct coronary artery bypass (MIDCAB) is a less-invasive alternative to full sternotomy off-pump coronary artery bypass (FS-OPCAB) revascularization of the left anterior descending artery (LAD). Some studies suggested that MIDCAB is associated with a greater risk of graft occlusion and repeat revascularization than FS-OPCAB LIMA-to-LAD grafting. Data comparing MIDCAB to FS-OPCAB with regard to long-term follow-up is scarce. We compared short- and long-term results of MIDCAB vs. FS-OPCAB revascularization over a maximum follow-up period of 10 years. Patients and methods From December 2009 to June 2020, 388 elective patients were included in our retrospective study. 229 underwent MIDCAB, and 159 underwent FS-OPCAB LIMA-to-LAD grafting. Inverse probability of treatment weighting (IPTW) was used to adjust for selection bias and to estimate treatment effects on short- and long-term outcomes. IPTW-adjusted Kaplan-Meier estimates by study group were calculated for all-cause mortality, stroke, the risk of repeat revascularization and myocardial infarction up to a maximum follow-up of 10 years. Results MIDCAB patients had less rethoracotomies (n = 13/3.6% vs. n = 30/8.0%, p = 0.012), fewer transfusions (0.93 units ± 1.83 vs. 1.61 units ± 2.52, p < 0.001), shorter mechanical ventilation time (7.6 ± 4.7 h vs. 12.1 ± 26.4 h, p = 0.005), and needed less hemofiltration (n = 0/0% vs. n = 8/2.4%, p = 0.004). Thirty-day mortality did not differ significantly between the two groups (n = 0/0% vs. n = 3/0.8%, p = 0.25). Long-term outcomes did not differ significantly between study groups. In the FS-OPCAB group, the probability of survival at 1, 5, and 10 years was 98.4%, 87.8%, and 71.7%, respectively. In the MIDCAB group, the corresponding values were 98.4%, 87.7%, and 68.7%, respectively (RR1.24, CI0.87-1.86, p = 0.7). In the FS group, the freedom from stroke at 1, 5, and 10 years was 97.0%, 93.0%, and 93.0%, respectively. In the MIDCAB group, the corresponding values were 98.5%, 96.9%, and 94.3%, respectively (RR0.52, CI0.25-1.09, p = 0.06). Freedom from repeat revascularization at 1, 5, and 10 years in the FS-OPCAB group was 92.2%, 84.7%, and 79.5%, respectively. In the MIDCAB group, the corresponding values were 94.8%, 90.2%, and 81.7%, respectively (RR0.73, CI0.47-1.16, p = 0.22). Conclusion MIDCAB is a safe and efficacious technique and offers comparable long-term results regarding mortality, stroke, repeat revascularization, and freedom from myocardial infarction when compared to FS-OPCAB.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Marcus-André Deutsch
- Department of Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
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Goto Y, Takagi S, Yanagisawa J, Okawa Y. Concomitant surgery of minimally invasive direct coronary artery bypass with left atrium appendage closure. BMJ Case Rep 2023; 16:e256642. [PMID: 38011944 PMCID: PMC10685910 DOI: 10.1136/bcr-2023-256642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 11/29/2023] Open
Abstract
Surgical approaches of minimally invasive direct coronary artery bypass and left atrial appendage exclusion are different, and issues may arise in cases of concomitant surgery. Moreover, the safety of concomitant procedures has not been established. A man in his 80s with a history of stroke required minimally invasive coronary artery bypass grafting and left atrial appendage closure for the stenosis of the left anterior descending artery and atrial fibrillation. He suffered from bladder bleeding, which required early reduction of anticoagulant and antiplatelet medication. Therefore, he wished for surgical treatment. A lateral incision was necessary for left atrial appendage closure in minimally invasive surgery. We performed totally endoscopic harvest of the internal thoracic artery without a robotic system. This method allowed the incision to be made more laterally. Combining the endoscopic harvest of the internal mammary artery with left atrial appendage closure via lateral incision may be a reasonable technique.
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Affiliation(s)
- Yoshihiro Goto
- Cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Sho Takagi
- Cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Junji Yanagisawa
- Cardiovascular surgery, Toyohashi Heart Center, Toyohashi, Japan
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Lianyong J, Pengkai G, Xuefeng Z, Fangbao D, Hao L. Simultaneous Minimally Invasive Coronary Artery Bypass Grafting and Lung Resection. Thorac Cardiovasc Surg 2023. [PMID: 37774755 DOI: 10.1055/a-2184-6624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND The best surgical treatment strategy for coexisting coronary artery disease (CAD) and lung cancer (LC) remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with CAD and LC. METHODS Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral minithoracotomy. Harvesting of the left internal mammary artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope. RESULTS Sixteen patients were included with a mean age of 67.13 ± 10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88 ± 94.48 minutes. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in one (6.25%), eight (50%), two (12.5%), and five (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included one case of postoperative bleeding, two lung infections, two cases of atelectasis, one case of pleural effusion, and one case of cardiac arrhythmia. All the patients were followed up for 1 to 57 months, cancer recurrence occurred in two patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction. CONCLUSION This simultaneous minimally invasive procedure is safe and effective for selected patients with CAD and LC.
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Affiliation(s)
- Jiang Lianyong
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Gao Pengkai
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Zhang Xuefeng
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
- Department of Radiology, The First Affiliated Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Ding Fangbao
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Liu Hao
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Reuthebuch O, Stein A, Koechlin L, Gahl B, Berdajs D, Santer D, Eckstein F. Five-Year Survival of Patients Treated with Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Compared with the General Swiss Population. Thorac Cardiovasc Surg 2023. [PMID: 37044119 DOI: 10.1055/s-0043-1768035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND To evaluate the midterm follow-up and 5-year survival outcome of the minimally invasive direct coronary artery bypass (MIDCAB) procedure compared with the survival of the general Swiss population. METHODS Retrospective study on preoperative data, intraoperative data, and postoperative outcome of patients who underwent MIDCAB surgery between June 2010 and February 2019. To assess validity of this surgical therapy, outcomes were compared with survival data of a gender- and age-matched cohort of the general Swiss population taken from the database of the Swiss Federal Statistical Office. RESULTS A total of 88 patients were included. Median (interquartile range [IQR[) age was 66 (56-75) years, and 27% (n = 24) were female. The median (IQR) length of the in-hospital stay was 7 (6-8) days. No postoperative stroke occurred. The 30-day mortality was 1.1% (n = 1). Reintervention for failed left internal mammary artery was needed in 1.1% (n = 1). The median (IQR) ejection fraction was 58% (47-60) preoperatively and remained stable during follow-up. The median (IQR) follow-up period was 3 (1.1-5.2) years. Five years postoperatively, 83% (confidence interval, 69-91) of the patients were alive, showing an overlap with the range of survival of the matched subcohort of the general Swiss population (range, 84-100%). CONCLUSION Though suffering from coronary heart disease, patients after MIDCAB show almost equal survival rates as an equivalent subcohort corresponding to the general Swiss population matched on age and gender. Thus, our data show this treatment to be safe and beneficial.
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Affiliation(s)
- Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Alina Stein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Denis Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
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Tiwari KK, Wadhawa V, Jawarkar M, Rathod D, Shah M, Manek P, Doshi C. Total arterial multivessels minimal invasive direct coronary artery bypass grafting via left minithoracotomy. Gen Thorac Cardiovasc Surg 2020; 69:8-13. [PMID: 32588292 DOI: 10.1007/s11748-020-01412-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Minimal Invasive Direct Coronary Artery Bypass Surgery (MIDCAB) is becoming popular and an important armamentarium for cardiac surgeons. We aimed to evaluate the result of MIDCAB total arterial revascularization. METHODS We have evaluated 216 patients who underwent MIDCAB multivessel total arterial revascularization through a left anterolateral mini thoracotomy. LIMA harvested in every patient, RIMA or radial artery used as second conduit. LIMA-RIMA Y or LIMA-RADIAL Y was made to accomplish multivessels total arterial revascularization. Post-operative graft patency was evaluated in all patients by CT coronary angiography at 6 months following discharge. RESULTS Mean age of patients was 52.5 ± 9.8 years. Average number of anastomosis performed were 2.34 ± 0.75. Multivessels total arterial CABG was accomplished in all individuals. There was no mortality or deep wound infection. Re-exploration was done in two patients for bleeding. In one patient emergency CPB was required. Average ICU and hospital stay was 1.52 ± 0.77 and 4.92 ± 1.46 days, respectively. Patients were mobilized earlier due to less pain. Wound healing of anterolateral thoracotomy was faster. In the follow up CT angiography 100% of the LIMA grafts were patent. CONCLUSIONS Multivessels total arterial MIDCAB can be accomplished safely in selected individuals. RIMA can be harvested in long standing diabetic patients with no concern for sternal wound healing. MIDCAB patients experience better cosmetics and early return to daily activities.
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Affiliation(s)
- Kaushal K Tiwari
- Department of Cardio Thoracic and Vascular Surgery, ADK Hospital Pvt. Ltd, Male, Maldives
| | - Vivek Wadhawa
- Department of Cardio Thoracic and Vascular Surgery, U.N.Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India.
| | - Manish Jawarkar
- Department of Cardio Thoracic and Vascular Surgery, U.N.Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India
| | - Divyesh Rathod
- Department of Cardio Thoracic and Vascular Surgery, U.N.Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India
| | - Mausam Shah
- Department of Cardio Thoracic and Vascular Surgery, U.N.Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India
| | - Pratik Manek
- Department of Cardio Thoracic and Vascular Surgery, U.N.Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India
| | - Chirag Doshi
- Department of Cardio Thoracic and Vascular Surgery, U.N.Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, 380016, Gujarat, India
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van der Merwe J, Casselman F, Vermeulen Y, Stockman B, Degrieck I, Van Praet F. Reasons for Conversion and Adverse Intraoperative Events in Robotically Enhanced Minimally Invasive Coronary Artery Revascularization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:251-260. [PMID: 32434406 DOI: 10.1177/1556984520920724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The transition from sternotomy access to minimally invasive coronary artery bypass grafting is associated with steep learning curves. This study reports the reasons for sternotomy conversions from robotically enhanced minimally invasive direct coronary artery bypass grafting (RE-MIDCAB) and describes potential risk reduction strategies. METHODS The perioperative data of 759 RE-MIDCAB patients (mean age 65.9 ± 10 years, 25.5% female, 30.2% multivessel disease) operated between July 1, 2002 and November 30, 2018 were reviewed for the reasons of conversion and adverse intraoperative events. Hybrid revascularization was planned in 204 (26.9%) patients. RESULTS Sternotomy conversion occurred in 30 (4.0%) patients. Lung adhesions and unsuccessful single-lung ventilation prohibited safe RE-MIDCAB internal thoracic artery (ITA) harvesting in 11 (36.7%) and 1 (3.3%) patients, respectively. ITA dysfunction (n = 11, 36.7%) and inadequate target vessel visualization (n = 3, 10.0%) were among the anatomical reasons for conversions. Adverse intraoperative events included ventricle perforation (n = 1, 3.3%) and sustained ventricular arrhythmia (n = 1, 3.3%). The in-hospital mortality and mean length of hospitalization for sternotomy conversion were 3.3% (n = 1 of 30) and 13.4 ± 14.5 days, respectively. Perioperative morbidities included pneumonia (n = 4, 13.3%). Premorbid renal dysfunction predicted sternotomy conversion at the 5% level of significance. CONCLUSIONS RE-MIDCAB provides an attractive surgical platform for primary- or hybrid coronary artery procedures. The progressive increase in patient risk profiles, strict quality control, and focus on clinical governance require awareness of reasons that potentially contribute RE-MIDCAB to sternotomy conversion to ensure safe and sustainable programs.
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Affiliation(s)
- Johan van der Merwe
- 37467 The Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Filip Casselman
- 37467 The Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Yvette Vermeulen
- 37467 The Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Bernard Stockman
- 37467 The Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Ivan Degrieck
- 37467 The Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Frank Van Praet
- 37467 The Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
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