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Yaşar E, Duman ZM, Bayram M, Kahraman MZ, Köseoğlu M, Kadiroğulları E, Aydın Ü, Onan B. Predictors and outcomes of conversion to sternotomy in minimally invasive coronary artery bypass grafting. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:161-168. [PMID: 37484640 PMCID: PMC10357860 DOI: 10.5606/tgkdc.dergisi.2023.24552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/07/2023] [Indexed: 07/25/2023]
Abstract
Background This study aims to investigate the risk factors and surgical outcomes of conversion to median sternotomy in minimally invasive direct coronary artery bypass grafting. Methods Between January 2017 and July 2022, a total of 274 patients (246 males, 28 females; mean age: 57.0±9.6 years; range, 33 to 81 years) who underwent conventional (n=116) or robot-assisted (n=158) minimally invasive direct coronary artery bypass grafting were retrospectively analyzed. The primary outcome measure of the study was conversion to median sternotomy, and the secondary outcome measures were operative mortality, length of intensive care unit and hospital stay. Results Conversion to median sternotomy was required in 26 (9.5%) patients. The most common cause of conversion was intramyocardial left anterior descending artery (27.0%). Among preoperative and operative characteristics, only age was statistically significant risk factor for conversion to sternotomy (odds ratio=1.06, p=0.01). Operative mortality occurred in one patient (0.36%) patient in the entire cohort. The length of intensive care unit and hospital stay was significantly longer in patients requiring conversion to median sternotomy (p=0.002 and p<0.001, respectively). There was no significant difference in other postoperative outcomes between the two groups (p>0.05). Conclusion Intramyocardial left anterior descending artery is the most common reason for conversion to sternotomy, and older age increases the risk of conversion. Minimally invasive coronary artery bypass grafting can be performed with satisfactory results, even if it requires conversion to sternotomy.
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Affiliation(s)
- Emre Yaşar
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Zihni Mert Duman
- Department of Cardiovascular Surgery, Cizre State Hospital, Şırnak, Türkiye
| | - Muhammed Bayram
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Meliha Zeynep Kahraman
- Department of Anesthesiology and Reanimation, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Köseoğlu
- Department of Anesthesiology and Reanimation, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Ersin Kadiroğulları
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Ünal Aydın
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
| | - Burak Onan
- Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye
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de Jong AR, Gianoli M, Namba HF, Roefs MM, Singh S, Segers P, Jacob KA, Suyker WJL. A Nationwide Study of Clinical Outcomes After Robot-Assisted Coronary Artery Bypass Surgery and Hybrid Revascularization in the Netherlands. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:73-79. [PMID: 36802970 PMCID: PMC9989225 DOI: 10.1177/15569845231154046] [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: 02/22/2023]
Abstract
OBJECTIVE Robot-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) surgery and hybrid coronary revascularization (HCR) are minimally invasive alternative strategies to conventional coronary artery bypass surgery in patients with isolated left anterior descending (LAD) stenosis or multivessel coronary disease. We analyzed a large, multicenter data-set based on the Netherlands Heart Registration including all patients undergoing RA-MIDCAB. METHODS We included 440 consecutive patients who underwent RA-MIDCAB with the left internal thoracic artery to LAD between January 2016 and December 2020. A proportion of patients underwent percutaneous coronary intervention (PCI) of non-LAD vessels (i.e., HCR). The primary outcome was all-cause mortality at median follow-up of 1 year, which was subdivided into cardiac and noncardiac. Secondary outcomes included target vessel revascularization (TVR) at median follow-up as well as 30-day mortality, perioperative myocardial infarction, reoperation for bleeding or anastomosis-related problems, and in-hospital ischemic cerebrovascular accident (iCVA). RESULTS Among all patients, 91 (21%) underwent HCR. At median (IQR) follow-up of 19 (8 to 28) months, 11 patients (2.5%) had died. In 7 patients, the cause of death was defined as cardiac. TVR occurred in 25 patients (5.7%), of whom 4 underwent CABG and 21 underwent PCI. At 30-day follow-up, 6 patients (1.4%) had a perioperative myocardial infarction, of whom 1 died. One patient (0.2%) developed an iCVA, and 18 patients (4.1%) underwent reoperation for bleeding or anastomosis-related problems. CONCLUSIONS The clinical outcomes of patients undergoing RA-MIDCAB or HCR in the Netherlands are good and promising when compared with the currently available literature.
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Affiliation(s)
| | | | | | - Maaike M Roefs
- Netherlands Heart Registration, Utrecht, The Netherlands
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Piperata A, Busuttil O, Jansens JL, Modine T, Pernot M, Labrousse L. A Single Center Initial Experience with Robotic-Assisted Minimally Invasive Coronary Artery Bypass Surgery (RA-MIDCAB). J Pers Med 2022; 12:1895. [PMID: 36422071 PMCID: PMC9694867 DOI: 10.3390/jpm12111895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Minimally invasive procedures have demonstrated their effectiveness in reducing the recovery times while ensuring optimal results and minimizing complications. Regarding the coronary artery surgical revascularization field, the evolution of techniques and technology is permitting new surgical strategies that are increasingly precise and suitable for each patient. We present an initial single center experience with a case series of patients successfully treated with combined robotic harvesting of the left internal mammary artery (LIMA) and minimally invasive direct coronary artery bypass graft (MIDCAB) for the anastomosis. METHODS We retrospectively reviewed the records of patients who underwent minimally invasive coronary artery revascularization with the use of two combined techniques at our Institution between January 2021 and October 2022. RESULTS A total of 17 patients underwent coronary artery bypass grafting with the described approach. The median cardiopulmonary bypass (CPB) and cross-clamp times were 83 min (76-115) and 38 min (32-58), respectively. The median intensive care unit (ICU) and hospital stay were 2 days (1-4) and 8 days (6-11), respectively. The procedure's success was achieved in 100% of patients. The 30-day mortality was 0%. CONCLUSIONS Considering all the limitations related to the small sample, the presented results of a hybrid approach for minimally invasive coronary artery bypass grafting (CABG) appears to be encouraging and acceptable. The main advantage of this approach is related to the reduction of postoperative pain and pulmonary complications.
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Affiliation(s)
- Antonio Piperata
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Olivier Busuttil
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Jean-Luc Jansens
- Department of Cardiac Surgery, Erasme Hospital of Brussels, Belgium free University of Brussels (ULB), Hôpital Erasme, 1070 Brussels, Belgium
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
| | - Louis Labrousse
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, 33604 Pessac, France
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Manuel L, Fong LS, Betts K, Bassin L, Wolfenden H. LIMA to LAD grafting returns patient survival to age-matched population: 20-year outcomes of MIDCAB surgery. Interact Cardiovasc Thorac Surg 2022; 35:6709348. [PMID: 36130278 PMCID: PMC9519092 DOI: 10.1093/icvts/ivac243] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucy Manuel
- Cardiothoracic Surgery Department, Royal North Shore Hospital , St Leonards, Australia
| | - Laura S Fong
- Cardiothoracic Surgery Department, Prince of Wales Hospital , Randwick, Australia
| | - Kim Betts
- School of Public Health, Curtin University , Perth, Australia
| | - Levi Bassin
- Cardiothoracic Surgery Department, Royal North Shore Hospital , St Leonards, Australia
- Cardiothoracic Surgery Department, Prince of Wales Hospital , Randwick, Australia
| | - Hugh Wolfenden
- Cardiothoracic Surgery Department, Prince of Wales Hospital , Randwick, Australia
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Manuel L, Fong LS, Wolfenden H, Bassin L. 'Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?'. Ann Med Surg (Lond) 2020; 57:264-267. [PMID: 32884744 PMCID: PMC7453057 DOI: 10.1016/j.amsu.2020.07.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 11/29/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Is totally endoscopic coronary artery bypass grafting compared with minimally invasive direct coronary artery bypass grafting associated with superior outcomes in patients with isolated left anterior descending disease?’ Altogether more than 118 papers were found using the reported search, of which 4 represented the best evidence to answer the clinical question, which included 2 prospective cohort studies and 2 retrospective observational studies. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. There is a significant variation within the MIDCAB and TECAB techniques amongst the studies-including the experience of the surgeon, use of cardiopulmonary bypass, patient selection, and target vessel grafting strategies-highlighting the complexity of comparing these two minimally invasive procedures. Operative times were comparable across all studies, with TECAB patients having higher transfusions rates and conversion rates to either a median sternotomy or MIDCAB procedure. Overall safety was comparable between the two cohort groups, with similar length of stay and 30-day mortality. However, the TECAB group were more likely to require re-operation for bleeding and reintervention for early revascularisation with greater total hospital costs than the MIDCAB patients. Based on the available evidence, we conclude that TECAB is associated with a higher rate of transfusions, conversion to median sternotomy or MIDCAB, early graft failure and reintervention compared to the MIDCAB approach. We advise caution in adopting a TECAB approach. Coronary Artery Bypass Grafting remains the gold standard for complex multi-vessel disease. Demand for minimally invasive and robotic procedures is increasing. Controversy remains regarding the optimal method for robotically assisted coronary grafting. Overall safety is comparable between TECAB and MIDCAB. TECAB is associated with a higher rate of early graft failure and reintervention.
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Affiliation(s)
- Lucy Manuel
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
- Corresponding author. Department of Cardiothoracic Surgery, Royal North Shore Hospital St Leonards, Australia.
| | - Laura S. Fong
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Hugh Wolfenden
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Levi Bassin
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
- Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
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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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Guenther TM, Chen SA, Balkhy HH, Kiaii B. Robotic Coronary Artery Bypass Grafting: The Whole 9 Yards. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:204-210. [DOI: 10.1177/1556984520922931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Timothy M. Guenther
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
- Department of Surgery, David Grant USAF Medical Center, Fairfield, CA, USA
| | - Sarah A. Chen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Husam H. Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
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The Future of Open Heart Surgery in the Era of Robotic and Minimal Surgical Interventions. Heart Lung Circ 2020; 29:49-61. [DOI: 10.1016/j.hlc.2019.05.170] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/17/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
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