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Jinghui L, Yin Y, Xiaokaitijiang M, Yipeng T, Lianqun W, Yunpeng B, Zhejun Z, Nan J, Qiang W, Qingliang C, Dong X, Dongyan Y, Zhigang G, Feng Z. Comparison of clinical effects of coronary artery bypass grafting between left anterior small thoracotomy approach and lower-end sternal splitting approach. J Int Med Res 2024; 52:3000605241247656. [PMID: 38818531 PMCID: PMC11143834 DOI: 10.1177/03000605241247656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 03/28/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE To compare the clinical effects of coronary artery bypass grafting (CABG) between the left anterior small thoracotomy (LAST) and lower-end sternal splitting (LESS) approaches for coronary artery disease. METHODS In total, 110 patients who underwent LAST from October 2015 to December 2020 in Tianjin Chest Hospital were selected as the observation group. Patients who underwent the LESS approach during the same period were analyzed. The propensity score was calculated by a logistic regression model, and nearest-neighbor matching was used for 1:1 matching. RESULTS The length of hospital stay and ventilator support time were significantly shorter in the LAST than LESS group. The target vessels in the obtuse marginal branch and posterior left ventricular artery branch grafts were significantly more numerous in the LAST than LESS group, but those in the right coronary artery graft were significantly less numerous in the LAST group. CONCLUSIONS CABG using either the LAST or LESS approach is safe and effective, especially in low-risk patients. The LAST approach can achieve complete revascularization for multivessel lesions and has the advantages of less trauma and an aesthetic outcome. However, it requires a certain learning curve to master the surgical techniques and has specific surgical indications.
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Affiliation(s)
- Li Jinghui
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
- Clinical College of Thoracic Medicine, Tianjin Medical University, Tianjin, P.R. China
| | - Yang Yin
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
- Clinical College of Thoracic Medicine, Tianjin Medical University, Tianjin, P.R. China
| | | | - Tang Yipeng
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Wang Lianqun
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Bai Yunpeng
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Zhang Zhejun
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Jiang Nan
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Wang Qiang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Chen Qingliang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Xu Dong
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Yang Dongyan
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Guo Zhigang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Zhao Feng
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
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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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Demirsoy E, Mavioglu I, Dogan E, Gulmez H, Dindar I, Erol MK. The Feasibility and Early Results of Multivessel Minimally Invasive Coronary Artery Bypass Grafting for All Comers. J Clin Med 2023; 12:5663. [PMID: 37685730 PMCID: PMC10488478 DOI: 10.3390/jcm12175663] [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: 07/28/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES Cardiovascular surgery advancements have emerged with various minimally invasive approaches for treating multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. We present our clinical experience and minimally invasive coronary bypass techniques through minithoracotomy, which we apply without selection to patients who have decided to have elective surgery for multivessel isolated coronary artery disease. METHODS It consists of 230 consecutive patients operated by the same team with this method between July 2020 and September 2022. The patients were assigned to one of the two methods preoperatively to their accompanying comorbidities and operated on either with blood cardioplegia via 5 to 7 cm left anterior minithoracotomy, with on-pump clamped technique or without pump via left anterolateral minithoracotomy. RESULTS Mortality was observed in two of our patients (0.9%), but myocardial infarction was not observed in our patients in the early postoperative period. None of our patients required conversion to sternotomy (0%). Five patients' needed reoperation from the same incision due to postoperative bleeding (2.2%), and atrial fibrillation developed in 17 patients in the postoperative period (7.4%). The mean number of bypasses was found to be 3.0 ± 0.9. CONCLUSIONS Minimally invasive coronary artery bypass surgery via minithoracotomy can be routinely reproduced safely. More long-term results and more multicenter studies are needed for more widespread acceptance of the technique.
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Affiliation(s)
- Ergun Demirsoy
- Division of Cardiovascular Surgery, Sisli Kolan International Hospital, Kaptanpaşa Mahellesi Darulaceze Caddesi No 14, Sisli, 34384 Istanbul, Turkey
| | - Ilhan Mavioglu
- Division of Cardiovascular Surgery, Private Practice, Sisli, 34394 Istanbul, Turkey;
| | - Emre Dogan
- Division of Cardiovascular Surgery, Sisli Kolan International Hospital, Kaptanpaşa Mahellesi Darulaceze Caddesi No 14, Sisli, 34384 Istanbul, Turkey
| | - Harun Gulmez
- Division of Cardiovascular Surgery, Sisli Kolan International Hospital, Kaptanpaşa Mahellesi Darulaceze Caddesi No 14, Sisli, 34384 Istanbul, Turkey
| | - Ismet Dindar
- Division of Cardiology, Sisli Kolan International Hospital, 34384 Istanbul, Turkey
| | - Mustafa Kemal Erol
- Division of Cardiology, Sisli Kolan International Hospital, 34384 Istanbul, Turkey
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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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Mavioglu I, Vallely MP. Minimally invasive off-pump anaortic coronary artery bypass (MACAB). J Card Surg 2022; 37:4944-4951. [PMID: 36378893 DOI: 10.1111/jocs.17180] [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: 06/21/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Minimally invasive direct coronary artery bypass has enabled coronary artery bypass graft to compete with the appeal of less invasive percutaneous coronary procedures. Favorable results of coronary artery bypass surgery performed without the use of cardiopulmonary bypass and without touching the aorta (anOPCAB) have enabled the development and use of minimally invasive methods. METHODS Between 2016 and 2021, 112 patients underwent multivessel coronary bypass surgery performed using a minimally invasive method through a small thoracotomy in the left chest with off-pump, anaortic, and all-arterial grafts (Minimally Invasive Off-Pump Anaortic Coronary Artery Bypass [MACAB]). Patient data were collected and retrospectively analyzed. Eight series from the literature using the multivessel mini-OPCAB and MACAB technique were also evaluated. RESULTS Collectively, from the literature, 2729 patients underwent an average of 2.4 bypasses with an early mortality rate of 0.7% and a stroke rate of 0.16%. In our MACAB case series, 112 patients underwent an average of 2.9 bypasses with a mortality rate of 1.8% and a stroke rate of 0%. CONCLUSION MACAB can be performed safely by experienced surgeons and reduces neurological injury and surgical trauma and may be a good alternative for multivessel stenting. Simulation systems are essential for its dissemination, and teams dedicated to coronary surgery-with subspecialty expertise-are necessary to achieve good outcomes.
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Affiliation(s)
- Ilhan Mavioglu
- Cardiovascular Surgery, Cardiac Surgical Clinic of Private Cardiac Surgeons, Istanbul, Turkey
| | - Michael P Vallely
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, New York, USA
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Çaynak B, Sicim H. Routine minimally invasive approach via left anterior mini‐thoracotomy in multivessel coronary revascularization. J Card Surg 2022; 37:769-776. [DOI: 10.1111/jocs.16259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Barış Çaynak
- Department of Cardiovascular Surgery Private Medical Practice İstanbul Turkey
| | - Hüseyin Sicim
- Department of Cardiovascular Surgery Kırklareli Training and Research Hospital Kırklareli Turkey
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Van Praet KM, Kofler M, Shafti TZN, El Al AA, van Kampen A, Amabile A, Torregrossa G, Kempfert J, Falk V, Balkhy HH, Jacobs S. Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature. ACTA ACUST UNITED AC 2021; 16:e08. [PMID: 34295373 PMCID: PMC8287382 DOI: 10.15420/icr.2021.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/29/2021] [Indexed: 12/21/2022]
Abstract
Minimally invasive coronary revascularisation was originally developed in the mid 1990s as minimally invasive direct coronary artery bypass (MIDCAB) grafting is a less invasive approach compared to conventional coronary artery bypass grafting (CABG) to address targets in the left anterior descending coronary artery (LAD). Since then, MIDCAB has evolved with the adoption of a robotic platform and the possibility to perform multivessel bypass procedures. Minimally invasive coronary revascularisation surgery also allows for a combination between the benefits of CABG and percutaneous coronary interventions for non-LAD lesions – a hybrid approach. Hybrid coronary revascularisation results in fewer blood transfusions, shorter hospital stay, decreased ventilation times and patients return to work sooner when compared to conventional CABG. This article reviews the available literature, describes standard approaches and considers topics, such as limited access procedures, indications and patient selection, diagnostics and imaging, techniques, anastomotic devices, hybrid coronary revascularisation and outcome analysis.
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Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
| | - Timo Z Nazari Shafti
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Berlin Institute of Health Berlin, Germany
| | - Alaa Abd El Al
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
| | - Antonia van Kampen
- ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Leipzig Heart Center, University Clinic for Cardiac Surgery Leipzig, Germany
| | - Andrea Amabile
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Gianluca Torregrossa
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany.,ZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin, Germany.,Berlin Institute of Health Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin Berlin, Germany.,Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zurich, Switzerland
| | - Husam H Balkhy
- Division of Minimally Invasive and Robotic Cardiac Surgery, Department of Surgery, University of Chicago Chicago, IL, US
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin Germany
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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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [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
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - Jimmy Kang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Andrew Maitland
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
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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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Sakaguchi T, Totsugawa T, Tamura K, Hiraoka A, Ryomoto M, Sekiya N, Chikazawa G, Yoshitaka H. Minimally invasive coronary artery bypass grafting: useful routine option for coronary revascularization in selected cases. Gen Thorac Cardiovasc Surg 2020; 68:1128-1133. [PMID: 32212032 DOI: 10.1007/s11748-020-01336-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The safety and feasibility of minimally invasive coronary artery bypass grafting (MICS CABG) were evaluated. METHODS From December 2012 to March 2019, 122 consecutive patients underwent MICS CABG via a left mini-thoracotomy under direct vision. The internal thoracic artery (ITA) was harvested from all, while bilateral ITAs (BITAs) were used in 36 patients, with the second ITA as an in situ (n = 18) or free (n = 18) graft. Proximal anastomosis of the free graft (ITA, radial artery, or saphenous vein segments) was performed directly onto the ascending aorta, or from the ITA as a Y- or I-composite graft. RESULTS Patient ages ranged from 38 to 89 years (mean 66.9 ± 9.6 years) and 102 were males. MICS CABG was completed without conversion in 116 patients (95.1%), of whom 76 underwent multivessel bypass grafting, with 2 grafts used in 52 and 3 or more in 24 patients. A cardiopulmonary bypass was performed in 17 patients. Perioperative mortality occurred in 1 patient who died of advanced cancer. There were no cases of reoperation for bleeding, stroke, or chest wound infection. The perioperative transfusion rate was 11.2%. Early graft patency was noted in 97.1%. The rate of freedom from major adverse cardiac and cerebrovascular events (all-cause death, myocardial infarction, stroke, and repeated revascularization) was 89.7% at 5 years. CONCLUSIONS MICS CABG is feasible and showed good mid-term outcomes. BITAs can be harvested with this approach; thus, allowing for various graft designs. We recommend this as a useful option for coronary revascularization in selected cases.
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Affiliation(s)
- Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Toshinori Totsugawa
- The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Okayama, 700-0804, Japan
| | - Kentaro Tamura
- The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Okayama, 700-0804, Japan
| | - Arudo Hiraoka
- The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Okayama, 700-0804, Japan
| | - Masaaki Ryomoto
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Naosumi Sekiya
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Genta Chikazawa
- The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Okayama, 700-0804, Japan
| | - Hidenori Yoshitaka
- The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Okayama, 700-0804, Japan
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Off-pump coronary artery bypass grafting via left anterior thoracotomy from the 4th costal space in a patient with total laryngectomy and a permanent tracheostoma. Gen Thorac Cardiovasc Surg 2019; 68:633-636. [PMID: 31111321 DOI: 10.1007/s11748-019-01143-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Median sternotomy is the standard approach for coronary artery bypass grafting. Herein, we performed off-pump coronary artery bypass grafting via left anterior thoracotomy from the 4th costal space in an unstable angina pectoris patient with total laryngectomy and a permanent tracheostoma. In this patient, median sternotomy had high risks of surgical-site infection and tracheal injury. To avoid these risks, we selected left anterior thoracotomy. Initially, it was difficult to expose the ascending aorta and postdescending branch. With extension of the skin incision to the median area and division of the 5th and 6th ribs and costal arch, we could expose the anastomotic sites, including the ascending aorta and postdescending branch, without median sternotomy conversion. We performed multiple coronary artery bypass graft procedures safely. This approach might be an additional surgical option in patients with total laryngectomy and a permanent tracheostoma.
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12
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Une D, Sakaguchi T. Initiation and modification of minimally invasive coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2018; 67:349-354. [PMID: 30569257 DOI: 10.1007/s11748-018-1050-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/10/2018] [Indexed: 11/24/2022]
Abstract
Minimally invasive coronary artery bypass grafting (MICS CABG) via a small left thoracotomy has been proposed as an alternative to standard coronary artery bypass grafting. However, this technique is still limited to skillful surgeons. Off-pump multi-vessel bypass grafting and the use of bilateral internal thoracic arteries are particularly challenging via a small thoracotomy, while they are widely performed via a full median sternotomy. The purpose of this review is to serve as a guide for the proper introduction of MICS CABG in the current era. We examine the advances, current techniques, outcomes and learning curves of MICS CABG and discuss the safe introduction.
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Affiliation(s)
- Dai Une
- Department of Cardiovascular Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Minimally invasive coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 2018; 34:302-309. [PMID: 33060953 DOI: 10.1007/s12055-017-0631-x] [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: 10/23/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022] Open
Abstract
Minimally invasive cardiac surgery (MICS)-CABG is a technique that at its core has patient comfort, early return to routine activities, meeting patient expectations for less invasive options, and maintaining the highest possible standards of care and outcomes. The technique requires not only surgical dexterity but also integration of significant technological advancements in patient care. At a time when percutaneous interventions are often prescribed on the pretext of increased patient comfort and demand, minimally invasive myocardial revascularization becomes even more relevant. Minimally invasive myocardial revascularization is ever evolving and encompasses both small-incision open techniques as well as endoscopic-assisted procedures. The success of the procedure depends not only on the learning curve and familiarity with the technology but also on appropriate patient selection. Mere feasibility of the technique is not sufficient, and the results have to be comparable with the long-established techniques of conventional coronary artery bypass grafting both in terms of early morbidity and mortality as well as long-term outcomes. In this review, we discuss patient selection and technical aspects of minimally invasive coronary artery bypass grafting. We also provide an evidence-based comparison to early and long-term outcomes with conventional coronary artery bypass grafting. Finally, we review the uptake and outcomes of minimally invasive revascularization in the Indian subcontinent.
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Literaturübersicht 2017 zur Koronarchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-018-0236-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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15
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Nambiar P, Kumar S, Mittal CM, Saksena K. Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future? J Thorac Cardiovasc Surg 2018; 155:190-197. [DOI: 10.1016/j.jtcvs.2017.07.088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/21/2017] [Accepted: 07/18/2017] [Indexed: 10/18/2022]
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