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Sef D, Thet MS, Hashim SA, Kikuchi K. Minimally Invasive Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease: A Systematic Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241265867. [PMID: 39267397 DOI: 10.1177/15569845241265867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
OBJECTIVE We conducted a systematic review of all available evidence on the feasibility and safety of minimally invasive coronary artery bypass grafting (MICS CABG) in patients with multivessel coronary artery disease (CAD). METHODS A systematic literature search in PubMed, MEDLINE via Ovid, Embase, Scopus, and Web of Science was performed to identify all relevant studies evaluating outcomes of MICS CABG among patients with multivessel CAD and including at least 15 patients with no restriction on the publication date. RESULTS A total of 881 studies were identified, of which 26 studies met the eligibility criteria. The studies included a total of 7,556 patients. The average patient age was 63.3 years (range 49.5 to 69.0 years), male patients were an average of 77.8% (54.0% to 89.8%), and body mass index was 29.8 kg/m2 (24.5 to 30.1 kg/m2). Early mortality and stroke were on average 0.6% (range 0% to 2.0%) and 0.4% (range 0% to 1.3%), respectively. The average number of grafts was 2.8 (range 2.1 to 3.7). The average length of hospital stay was 5.6 days (range 3.1 to 9.3 days). CONCLUSIONS MICS CABG appears to be a safe method in well-selected patients with multivessel CAD. This approach is concentrated at dedicated centers, and there is no widespread application, although it has potential to be widely applicable as an alternative for surgical revascularization. However, large randomized controlled studies with longer follow-up are still required to compare the outcomes with conventional CABG and other revascularization strategies.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, University Hospitals of Leicester, UK
| | - Myat Soe Thet
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London & Imperial College Healthcare NHS Trust, UK
| | - Shahrul Amry Hashim
- Department of Cardiothoracic Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Keita Kikuchi
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Japan
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Claessens J, Packlé L, Oosterbos H, Smeets E, Geens J, Gielen J, Van Genechten S, Heuts S, Maessen JG, Yilmaz A. Totally endoscopic coronary artery bypass grafting: experience in 1500 patients. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae159. [PMID: 39287016 PMCID: PMC11434154 DOI: 10.1093/icvts/ivae159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 09/13/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVES Totally endoscopic coronary artery bypass grafting (TECAB) is a minimally invasive approach to achieve surgical revascularization through a minimally invasive approach. Still, data regarding non-robotic TECAB are limited. This report presents the results of a TECAB technique using long-shafted instruments, defined as Endo-CABG, from a single-centre experience in 1500 consecutive patients. METHODS One thousand and five hundred patients underwent Endo-CABG between January 2016 and February 2023. Data were collected retrospectively, and patients were followed up for 1 year. The primary outcome of this study was major adverse cardiac and cerebrovascular events (MACCE)-free survival. Secondary efficacy outcomes were graft failure and mortality. Furthermore, we analysed factors influencing long-term freedom from MACCE and all-cause mortality. RESULTS The mean age was 68 [61-75] years, of which 193 (12.87%) were octogenarians. Multivessel disease was present in 1409 (93.93%) patients, and the mean EuroSCORE II was 1.64 [1.09-2.92] %. All patients underwent full arterial revascularization with bilateral internal mammary grafting in 88.47%. Graft failure occurred in 1.80% of cases after 1 year (n = 27). Thirty-day mortality was 1.73% (n = 26), 1-year survival was 94.7% (95% CI: 93.5-95.9%; n = 26) and 1-year MACCE-free survival was 91.7% (95% CI: 90.2-93.2%). Age, left ventricular ejection fraction, arterial hypertension and urgency were significantly associated with 1-year MACCE-free survival. CONCLUSIONS Endo-CABG appears to be a safe procedure, achieves surgical revascularization and provides good outcomes regarding graft failure and MACCE at 1 year, while age, left ventricular ejection fraction, arterial hypertension and urgency were associated with 1-year outcomes.
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Affiliation(s)
- Jade Claessens
- UHasselt—Hasselt University, Limburg Clinical Research Center, Hasselt, Belgium
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Loren Packlé
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Hanne Oosterbos
- UHasselt—Hasselt University, Limburg Clinical Research Center, Hasselt, Belgium
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Elke Smeets
- UHasselt—Hasselt University, Limburg Clinical Research Center, Hasselt, Belgium
| | - Jelena Geens
- UHasselt—Hasselt University, Limburg Clinical Research Center, Hasselt, Belgium
| | - Jens Gielen
- UHasselt—Hasselt University, Limburg Clinical Research Center, Hasselt, Belgium
| | | | - Samuel Heuts
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
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Di Franco A. Navigating complexity among surgical myocardial revascularization strategies: Endoscopic coronary artery bypass gains support. Int J Cardiol 2024; 410:132240. [PMID: 38848772 DOI: 10.1016/j.ijcard.2024.132240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
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Marinakis S, Homsy K, Nakadi BE. Evolution of Surgical Expertise in Endoscopic Assisted Minimally Invasive Coronary Artery Bypass: Experience With 70 Consecutive Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241237482. [PMID: 38576097 DOI: 10.1177/15569845241237482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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Surve TA, Kazim MA, Sughra M, Mirza AMW, Murugan SK, Shebani KAM, Karishma F, Trada IJ, Mansour M, Asif K, Kaur L, Kamal A, Unachukwu N, Naveed A. Revascularization Modalities in Acute Coronary Syndrome: A Review of the Current State of Evidence. Cureus 2023; 15:e47207. [PMID: 38021880 PMCID: PMC10653013 DOI: 10.7759/cureus.47207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Acute coronary syndrome (ACS) stands as a leading global cause of mortality, underscoring the importance of effective prevention, early diagnosis, and timely intervention. While medications offer benefits to many patients, revascularization procedures such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and emerging hybrid approaches remain pivotal for ACS management. This review delves into the 2018 ESC/EACTS guidelines alongside an analysis of existing literature to shed light on the spectrum of revascularization methods. While both CABG and PCI demonstrate promising outcomes, the optimal choice between the two hinges on a comprehensive assessment of individual patient factors, anatomical complexity guided by advanced imaging, comorbidities, and age. The determination of whether to pursue culprit or total revascularization, as well as immediate or staged revascularization, is contingent upon various factors, including age, disease complexity, and clinical outcomes. This evidence-based decision-making process is orchestrated by a multidisciplinary heart team grounded in ongoing clinical evaluation. The primary objective of this review is to provide valuable insights into revascularization strategies and scrutinize the congruence of current guidelines with recent advancements in the field.
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Affiliation(s)
- Tahoora A Surve
- Internal Medicine, K. J. Somaiya Medical College, Mumbai, IND
| | | | - Mehak Sughra
- Internal Medicine, Gujranwala Teaching Hospital, Gujranwala, PAK
| | | | - Siva Kumar Murugan
- Internal Medicine, Meenakshi Medical College and Research Institute, Chennai, IND
| | | | - Fnu Karishma
- Internal Medicine, Ghulam Muhammad Mahar Medical College, Khairpur, PAK
| | | | - Mohammad Mansour
- General Medicine, University of Debrecen, Debrecen, HUN
- General Medicine, Jordan University Hospital, Amman, JOR
| | - Kainat Asif
- Medicine and Surgery, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, PAK
| | - Loveneet Kaur
- Medicine and Surgery, Government Medical College, Patiala, IND
| | - Amer Kamal
- Medicine, School of Medicine, The University of Jordan, Amman, JOR
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Marinakis S, Chaskis E, Cappeliez S, Homsy K, De Bruyne Y, Dangotte S, Poncelet A, Lelubre C, El Nakadi B. Minimal invasive coronary surgery is not associated with increased mortality or morbidity during the period of learning curve. Acta Chir Belg 2023; 123:481-488. [PMID: 35546309 DOI: 10.1080/00015458.2022.2076971] [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] [Received: 12/21/2021] [Accepted: 05/09/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Minimally invasive procedures for coronary revascularization have been performed for over 20 years; however, their technical complexity, steep learning curves and absence of training programs explain the weak acceptance of these techniques. The aim of this study is to describe the step-by-step learning process on how to establish a minimally invasive coronary artery revascularization program. The short-term outcomes of our first 30 patients were compared to our left internal mammary artery (LIMA) to left anterior descending (LAD) artery off pump coronary artery bypass (OPCAB) cohort as a quality control baseline. METHODS All patients who benefited from an endoscopic atraumatic coronary artery bypass (Endo-ACAB) in our hospital, from July 2018 to May 2020 (n = 30) were identified. Baseline demographics, peri, postoperative and laboratory data were extracted from each patient's medical records. These results were compared to our LIMA-LAD OPCAB cohort (n = 23). RESULTS Twenty-eight patients were planned for a single LIMA-LAD Endo-ACAB. The remaining two had a T-graft double Endo-ACAB. Ten patients had a hybrid revascularization with the culprit lesion being treated first. Three patients were converted to sternotomy because of a LIMA lesion during thoracoscopic harvesting. We accounted three major adverse cardiovascular events (MACE). Demographic, peri and postoperative data showed no significant differences between the Endo-ACAB and the OPCAB group. CONCLUSION Endo-ACAB is a technically demanding operation, however, it can safely be introduced in centers with no previous experience with no extra cost in terms of morbidity or mortality. Thoracoscopic LIMA harvesting is the most demanding surgical skill to acquire.
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Purmessur R, Wijesena T, Ali J. Minimal-Access Coronary Revascularization: Past, Present, and Future. J Cardiovasc Dev Dis 2023; 10:326. [PMID: 37623339 PMCID: PMC10455416 DOI: 10.3390/jcdd10080326] [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: 05/20/2023] [Revised: 07/16/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
Minimal-access cardiac surgery appears to be the future. It is increasingly desired by cardiologists and demanded by patients who perceive superiority. Minimal-access coronary artery revascularisation has been increasingly adopted throughout the world. Here, we review the history of minimal-access coronary revascularization and see that it is almost as old as the history of cardiac surgery. Modern minimal-access coronary revascularization takes a variety of forms-namely minimal-access direct coronary artery bypass grafting (MIDCAB), hybrid coronary revascularisation (HCR), and totally endoscopic coronary artery bypass grafting (TECAB). It is noteworthy that there is significant variation in the nomenclature and approaches for minimal-access coronary surgery, and this truly presents a challenge for comparing the different methods. However, these approaches are increasing in frequency, and proponents demonstrate clear advantages for their patients. The challenge that remains, as for all areas of surgery, is demonstrating the superiority of these techniques over tried and tested open techniques, which is very difficult. There is a paucity of randomised controlled trials to help answer this question, and the future of minimal-access coronary revascularisation, to some extent, is dependent on such trials. Thankfully, some are underway, and the results are eagerly anticipated.
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Affiliation(s)
- Rushmi Purmessur
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK
| | - Tharushi Wijesena
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK
| | - Jason Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK
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Claessens J, Goris P, Yilmaz A, Van Genechten S, Claes M, Packlé L, Pierson M, Vandenbrande J, Kaya A, Stessel B. Patient-Centred Outcomes after Totally Endoscopic Cardiac Surgery: One-Year Follow-Up. J Clin Med 2023; 12:4406. [PMID: 37445440 DOI: 10.3390/jcm12134406] [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: 05/05/2023] [Revised: 05/31/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Patient-centred outcomes have grown in popularity over recent years in surgical care research. These patient-centred outcomes can be measured through the health-related quality of life (HRQL) without professional interpretations. In May 2022, a study regarding patient-centred outcomes up to 90 days postoperatively was published. Fourteen days after surgery, the HRQL decreased and returned to baseline levels after 30 days. Next, the HRQL significantly improved 90 days postoperatively. However, this study only focuses on a short-term follow-up of the patients. Hence, this follow-up study aims to assess the HRQL one year after totally endoscopic cardiac surgery. At baseline, 14, 30, and 90 days, and one year after surgery, the HRQL was evaluated using a 36-item short form and 5-dimensional European QoL questionnaires (EQ-5D). Using the 36-item short form questionnaire, a physical and mental component score is calculated. Over the period of one year, this physical and mental component score and the EQ-5D index value significantly improve. According to the visual analogue scale of the EQ-5D, patients score their health significantly higher one year postoperatively. In conclusion, after endoscopic cardiac surgery, the HRQL is significantly improved 90 days postoperatively and remains high one year afterward.
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Affiliation(s)
- Jade Claessens
- Faculty of Medicine and Life Sciences, UHasselt-Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Pieter Goris
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Silke Van Genechten
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Marithé Claes
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Loren Packlé
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Maud Pierson
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Jeroen Vandenbrande
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Abdullah Kaya
- Faculty of Medicine and Life Sciences, UHasselt-Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Björn Stessel
- Faculty of Medicine and Life Sciences, UHasselt-Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
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Bildstein AC, Fourdrain A, Prud'homme R, Salami A, Garmi R, Veyssière A, Bénateau H. Rerouting the internal thoracic vessels as recipient vessels in head and neck reconstruction: comparison of two anatomic approaches. J Plast Reconstr Aesthet Surg 2022; 75:3715-3721. [DOI: 10.1016/j.bjps.2022.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/01/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
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90-Day Patient-Centered Outcomes after Totally Endoscopic Cardiac Surgery: A Prospective Cohort Study. J Clin Med 2022; 11:jcm11092674. [PMID: 35566800 PMCID: PMC9103144 DOI: 10.3390/jcm11092674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 01/27/2023] Open
Abstract
Over the past years, minimally invasive procedures have been developed to reduce surgical trauma after cardiac surgery. The value of patient-centered outcomes, including the quality of recovery after hospital discharge, is increasingly recognized. Identifying meaningful changes in postoperative function that might have a negative impact on patients without noticeable complications can provide a more comprehensive understanding of the impact on the patient’s life. In total, 209 patients were included in this trial. Of these, 193 patients underwent totally endoscopic cardiac surgery, 8 underwent cardiac surgery through a sternotomy, and 8 underwent transcatheter aortic valve implantation. Patients who previously underwent cardiac surgery were excluded. Quality of life was determined through the Short Form 36 and European Quality of Life-5 Dimensions questionnaires before the surgery and 14, 30, and 90 days afterward. In patients who underwent totally endoscopic cardiac surgery, the quality of life improved over the three time periods. The different domains of the questionnaire evolved in a positive manner. However, 14 days postoperatively, a decline in quality of life was noted, followed by a return to baseline at 30 days and an increase at 90 days. In conclusion, totally endoscopic cardiac surgery improves the quality of life 90 days after surgery.
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Claessens J, Yilmaz A, Awouters C, Oosterbos H, Thonnisen S, Benit E, Kaya A, Bataille Y. Clinical results after hybrid coronary revascularization with totally endoscopic coronary surgery. J Cardiothorac Surg 2022; 17:98. [PMID: 35505359 PMCID: PMC9062863 DOI: 10.1186/s13019-022-01840-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background The optimal revascularization strategy remains uncertain in multivessel coronary artery disease (MVCAD). The durability of the surgical grafts should be weighed against the decreased invasiveness of percutaneous coronary intervention (PCI). Hybrid coronary revascularization (HCR), a combination of PCI and surgery, could be a feasible alternative. This study aimed to investigate the occurrence of major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality after both endoscopic coronary artery bypass grafting (Endo-CABG) and the HCR procedure. Methods In this single-center retrospective observational study, 347 consecutive patients have been subjected to an Endo-CABG procedure, of which 103 underwent HCR between January 2016 and January 2018. A propensity score matching analysis was performed to match 103 Endo-CABG alone patients to the 103 HCR patients. The Endo-CABG procedure was performed through 3 endoscopic ports (5 mm) in the 2nd, 3rd, and 4th intercostal space and a utility port of 3 cm. Results In both the HCR and matched endo-CABG alone group, the 30-day mortality was acceptable (0% in the HCR group and 1.94% in the matched Endo-CABG alone group, p = 0.155). Additionally, the occurrence of MACCE after a mean follow-up of 1188 ± 538 days was similar in both groups (9.71% and 11.65% for the HCR and matched Endo-CABG alone group, respectively, p = 0.652). Still, the long-term all-cause mortality over this period was significantly higher in the matched Endo-CABG alone group (2.91% after the HCR procedure and 11.65% after matched Endo-CABG alone, p = 0.002). Conclusion HCR has some advantages over Endo-CABG alone regarding the all-cause mortality, cross-clamping time, intensive care unit, and hospital length of stay. Therefore, HCR may be a suitable alternative therapy for patients with MVCAD.
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Affiliation(s)
- Jade Claessens
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium. .,Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Martelarenlaan 45, Hasselt, Belgium.
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Camille Awouters
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Hanne Oosterbos
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Stef Thonnisen
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Martelarenlaan 45, Hasselt, Belgium
| | - Yoann Bataille
- Department of Cardiology, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
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Anastasiadis K, Antonitsis P, Deliopoulos A, Argiriadou H. From less invasive to minimal invasive extracorporeal circulation. J Thorac Dis 2021; 13:1909-1921. [PMID: 33841979 PMCID: PMC8024827 DOI: 10.21037/jtd-20-1830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Development of minimally invasive cardiac surgery (MICS) served the purpose of performing surgery while avoiding the surgical stress triggered by a full median sternotomy. Minimizing surgical trauma is associated with improved cosmesis and enhanced recovery leading to reduced morbidity. However, it has to be primarily appreciated that the extracorporeal circulation (ECC) stands for the basis of nearly all MICS procedures. With some fundamental modification and advancement in perfusion techniques, the use of ECC has become the enabling technology for the development of MICS. Less invasive cardiopulmonary bypass (CPB) techniques are based on remote cannulation and optimization of perfusion techniques with assisted venous drainage and use of centrifugal pump, so as to facilitate the demanding surgical maneuvers, rather than minimizing the invasiveness of the CPB. This is reflected in the increased duration of CPB required for MICS procedures. Minimal invasive Extracorporeal Circulation (MiECC) represents a major breakthrough in perfusion. It integrates all contemporary technological advancements that facilitate best applying cardiovascular physiology to intraoperative perfusion. Consequently, MiECC use translates to improved end-organ protection and clinical outcome, as evidenced in multiple clinical trials and meta-analyses. MICS performed with MiECC provides the basis for developing a multidisciplinary intraoperative strategy towards a "more physiologic" cardiac surgery by combining small surgical trauma with minimum body's physiology derangement. Integration of MiECC can advance MICS from non-full sternotomy for selected patients to a "more physiologic" surgery, which represents the real face of modern cardiac surgery in the transcatheter era.
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Affiliation(s)
| | | | | | - Helena Argiriadou
- Cardiothoracic Department, AHEPA University Hospital, Thessaloniki, Greece
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Alom S, Yang N, Bin Saeid J, Zeinah M, Harky A. Harvesting internal mammary artery: a narrative review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 61:790-801. [DOI: 10.23736/s0021-9509.20.11216-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Neurological outcome after minimally invasive coronary artery bypass surgery (NOMICS): An observational prospective cohort study. PLoS One 2020; 15:e0242519. [PMID: 33362277 PMCID: PMC7757846 DOI: 10.1371/journal.pone.0242519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background/Objectives Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive CABG procedure with retrograde arterial perfusion. The main objective of this study is to assess neurocognitive outcome after Endo-CABG. Methods/Design In this prospective observational cohort study, patients were categorised into: Endo-CABG (n = 60), a comparative Percutaneous Coronary Intervention (PCI) group (n = 60) and a healthy volunteer group (n = 60). A clinical neurological examination was performed both pre- and postoperatively, delirium was assessed postoperatively. A battery of 6 neurocognitive tests, Quality of life (QoL) and the level of depressive feelings were measured at baseline and after 3 months. Patient Satisfaction after Endo-CABG was assessed at 3-month follow-up. Primary endpoints were incidence of postoperative cognitive dysfunction (POCD), stroke and delirium after Endo-CABG. Secondary endpoints were QOL, patient satisfaction and the incidence of depressive feelings after Endo-CABG. Results In total, 1 patient after Endo-CABG (1.72%) and 1 patient after PCI (1.67%) suffered from stroke during the 3-month follow-up. POCD in a patient is defined as a Reliable Change Index ≤-1.645 or Z-score ≤-1.645 in at least two tests, and was found in respectively 5 and 6 patients 3 months after Endo-CABG and PCI. Total incidence of POCD/stroke was not different (PCI: n= 7 [15.9%]; Endo-CABG: n= 6 [13.0%], p = 0.732). ICU delirium after Endo-CABG was found in 5 (8.6%) patients. QoL increased significantly three months after Endo-CABG and was comparable with QoL level after PCI and in the control group. Patient satisfaction after Endo-CABG and PCI was comparable. At follow-up, the level of depressive feelings was decreased in all groups. Conclusions The incidence of poor neurocognitive outcome, including stroke, POCD and postoperative ICU delirium until three months after Endo-CABG is low and comparable with PCI. Trial registration Registered on ClinicalTrials.gov (NCT02979782)
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