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Cirugía coronaria de mínima invasión: técnicas y resultados. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Aluthman U, Bafageeh SW, Ashour MA, Barnawi HI, Bogis AA, Alamri R, Elmahrouk AF, AlGhamdi SA, Ismaeil N, Shihata M, Jamjoom AA. A robotic-assisted hybrid coronary revascularization program: Establishment and early experience in the Middle East. J Card Surg 2022; 37:4783-4789. [PMID: 36349707 DOI: 10.1111/jocs.17123] [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: 09/07/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hybrid coronary revascularization (HCR) is a technique that merges coronary artery bypass grafting surgery and percutaneous coronary intervention (PCI) approaches for the treatment of multivessel coronary artery disease. The surgical component of the procedure is minimally invasive and can be done using robotic technology that avoids the need for sternotomy. Our objective is to study all patients who underwent robotic-assisted HCR (RHCR) to evaluate the feasibility and safety of the procedure during the establishment phase. METHODS This study is a retrospective chart review conducted at King Faisal Specialist Hospital and Research Centre in Jeddah (KFSRC-J). The study focuses on patients who underwent RHCR between July 2018 to December 2020. The study was approved by the institutional review board #2020-103. RESULTS Robotic-assisted HCR was performed on 78 patients (mean age, 56 years (range, 43-72 years); 89.75% males) during the study phase. Left internal mammary artery grafting was used in all patients. There was no hospital mortality, and the mean hospital and intensive care unit (ICU) stay were 5.8 and 1.4 days, respectively. We found that 93.6% of the patients had no blood transfusion. There were no major adverse cardiac events (MACE) and perioperative MI recorded. There was a 3.8% rate of postoperative complications. The percentage of surgeries converted to conventional and re-exploration for bleeding were 1.2% and 2.6%, respectively. The average operation time was 164 min. CONCLUSION This study emphasizes on the safety and effectiveness of RHCR in treating patients with multivessel coronary artery disease. Moreover, robotic-assisted hybrid coronary revascularization offers an alternative, functionally complete revascularization option to a selected group of patients with minimal surgical trauma, short hospital and ICU length of stay, quick recovery, and little to no blood transfusion requirement.
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Affiliation(s)
- Uthman Aluthman
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Salman W Bafageeh
- College of Medicine, King Saud bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Mohammed A Ashour
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hani I Barnawi
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdulbadee A Bogis
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rawan Alamri
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed F Elmahrouk
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Nabeel Ismaeil
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammad Shihata
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Nenna A, Nappi F, Spadaccio C, Greco SM, Pilato M, Stilo F, Montelione N, Catanese V, Lusini M, Spinelli F, Chello M. Hybrid coronary revascularization in multivessel coronary artery disease: a systematic review. Future Cardiol 2022; 18:219-234. [PMID: 35006006 DOI: 10.2217/fca-2020-0244] [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: 11/21/2022] Open
Abstract
Aim: Hybrid coronary revascularization (HCR) for multivessel coronary artery disease (CAD) integrates coronary artery bypass grafting (CABG) and percutaneous intervention in a planned revascularization strategy. This systematic review summarizes the state of this art of this technique. Methods: Major databases searched until October 2021. Results: The available literature on HCR includes three randomized trials, ten meta-analysis and 27 retrospective studies. The greatest benefits are observed in patients with low-to-intermediate risk and less complex coronary anatomy; highly complex disease and the presence of risk factors favored conventional CABG in terms of adverse events and survival. Conclusion: HCR is an interesting approach for multivessel CAD but should not be considered a 'one-size-fits-all' procedure. Further studies will specify the subset of patients likely to benefit most from this hybrid approach.
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Affiliation(s)
- Antonio Nenna
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Francesco Nappi
- Cardiac surgery, Centre Cardiologique du Nord, Rue des Moulins Gémeaux 32, Saint Denis 93200, Paris, France
| | - Cristiano Spadaccio
- Cardiac surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank G814DY, Glasgow, United Kingdom
| | - Salvatore Matteo Greco
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy.,Cardiac surgery, ISMETT-IRCCS, Via Ernesto Tricomi 5, Palermo 90127, Italy
| | - Michele Pilato
- Cardiac surgery, ISMETT-IRCCS, Via Ernesto Tricomi 5, Palermo 90127, Italy
| | - Francesco Stilo
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Nunzio Montelione
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Vincenzo Catanese
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Mario Lusini
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Francesco Spinelli
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Massimo Chello
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
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Guo Y, Li D, Gao Y, Zhao J, An X, Liu Y, Gu S, Zhang X, Gao J, Su P. Clopidogrel Loading Dose 300 vs. 600 mg in Patients Undergoing One-Stop Hybrid Coronary Revascularization: A Prospective Single-Center Randomized Pilot Study. Front Surg 2021; 8:768860. [PMID: 34722627 PMCID: PMC8554050 DOI: 10.3389/fsurg.2021.768860] [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: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The optimal loading dose of clopidogrel in one-stop hybrid coronary revascularization (HCR) remains an “evidence-free” zone. This study aimed to compare the major bleeding and ischemic thrombotic events between different clopidogrel loading doses (300 vs. 600 mg) in one-stop HCR. Methods: In this prospective, single-center, randomized, and parallel pilot study, 100 patients receiving one-stop HCR were randomly assigned to the clopidogrel loading dose 300-mg group or 600-mg group in a 1:1 ratio. Major bleeding events and composite in-hospital ischemic thrombotic and adverse complications were evaluated after the procedure. Results: The results showed that postoperative mean chest drainage of the first 4 days and total drainage were comparable between the two groups. No differences were found in Bleeding Academic Research Consortium (BARC) coronary artery bypass grafting (CABG) related bleeding (4 vs. 2%, P = 1), PLATelet inhibition and patient Outcomes (PLATO) life-threatening bleeding (20 vs. 26%, P = 0.48), and PLATO major bleeding (70 vs. 76%, P = 0.5) in the two groups. The composite ischemic thrombotic and adverse events were also similar. Conclusions: In patients receiving one-stop HCR, clopidogrel 600 mg loading dose did not increase major bleeding events compared with 300 mg. More sufficient data is necessary to evaluate the potential benefits of 600 mg loading dose in one-stop HCR.
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Affiliation(s)
- Yulin Guo
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dongjie Li
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yingdi Gao
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Zhao
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiangguang An
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Song Gu
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xitao Zhang
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jie Gao
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Pixiong Su
- Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Fatehi Hassanabad A, Kang J, Maitland A, Adams C, Kent WDT. Review of Contemporary Techniques for Minimally Invasive Coronary Revascularization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:231-243. [PMID: 34081874 PMCID: PMC8217892 DOI: 10.1177/15569845211010767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Minimally invasive coronary revascularization techniques aim to avoid median sternotomy with its associated complications, while facilitating recovery and maintaining the benefits of surgical revascularization. The 3 most common procedures are minimally invasive coronary artery bypass grafting, totally endoscopic coronary artery bypass, and hybrid coronary revascularization. For a variety of reasons, including cost and technical difficulty, not many centers are routinely performing minimally invasive coronary revascularization. Nevertheless, many studies have assessed the safety and efficacy of each of these procedures in different clinical contexts. Thus far results have been promising, and with the evolution of procedural techniques, these approaches have the potential to redefine coronary revascularization in the future. This review highlights the current state of minimally invasive coronary revascularization techniques by exploring their benefits, identifying barriers to their adoption, and discussing future potential paradigms.
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Affiliation(s)
- Ali Fatehi Hassanabad
- 70401 Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - Jimmy Kang
- 12357 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Andrew Maitland
- 70401 Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - Corey Adams
- 70401 Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - William D T Kent
- 70401 Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
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Bastopcu M, Özhan A, Erdoğan SB, Kehlibar T. Factors associated with excessive bleeding following elective on-pump coronary artery bypass grafting. J Card Surg 2021; 36:1277-1281. [PMID: 33484200 DOI: 10.1111/jocs.15364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Excessive bleeding following cardiac surgery is associated with worse outcomes. We aimed to analyze preoperative and operative factors associated with excessive bleeding in coronary artery bypass patients to better understand which patients are under increased risk. METHODS The study was conducted as an observational study in a tertiary center for cardiac surgery by retrospective analysis of the hospital database. Patients were grouped according to chest tube output within the postoperative 24 h. Patients in the 4th percentile of chest tube output per kilogram were categorized as having excessive bleeding. Patients with excessive bleeding were compared with the other patients for preoperative and operative factors. Factors significant in univariate analysis were carried onto the multivariate analysis. RESULTS Patients with excessive bleeding were more likely to be males (91.4% vs. 78.7%, p = .002), have lower body mass index (BMI) (27.4 vs. 29.2, p < .001), and low platelets (6.9% vs. 1.5%, p = .006). Cardiopulmonary bypass (101.8 vs. 110.9 min, p = .022) time was longer in the excessive bleeding group. Patients with excessive bleeding were more likely to have more than three vessels revascularized. Male sex, lower BMI, low platelets, and longer cardiopulmonary bypass time were independently associated with increased bleeding. CONCLUSION Male sex, lower BMI, low platelet count, and longer cardiopulmonary bypass time are associated with extensive bleeding after elective coronary artery bypass surgery (CABG). Patients with higher bleeding risk should be identified preoperatively to account for adverse outcomes after CABG.
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Affiliation(s)
- Murat Bastopcu
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Abdulkerim Özhan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sevinç B Erdoğan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tamer Kehlibar
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Mizuno T, Ohuchi K, Fujiwara T, Oi K, Nagaoka E, Oishi K, Yashima M, Takeshita M, Arai H. Development of a Novel Heart Positioner for Minimally Invasive Coronary Surgery. Ann Thorac Surg 2020; 110:1746-1750. [PMID: 32599035 DOI: 10.1016/j.athoracsur.2020.04.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We developed a heart positioner, the Tentacles NEO, specifically designed for minimally invasive coronary artery bypass grafting (MICS-CABG). DESCRIPTION The device has 3 flexible suction tubes, with a suction cup at the tip of each tube. The suction tubes can be detached from the device body, allowing them to be manipulated in any direction through a small incision around the small thoracotomy. When the device displaces the heart, the suction cup moves behind the chest wall and does not crowd the operative field. EVALUATION Although the sideways suction force of the new device was as strong as that of the original device, Tentacles, the longitudinal and perpendicular force exerted was approximately 80% of the original device. Nevertheless, the new device could safely and favorably displace the heart in a pig model and even during off-pump CABG via sternotomy. During MICS-CABG, the device was able to displace the heart without crowding the operative field. CONCLUSIONS The new heart positioner, Tentacles NEO, is a useful and practical heart positioner suitable for MICS-CABG.
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Affiliation(s)
- Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Advanced Surgical Technology Research and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Katsuhiro Ohuchi
- Department of Advanced Surgical Technology Research and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Oi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiki Nagaoka
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyotoshi Oishi
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masafumi Yashima
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Takeshita
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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