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Thuan PQ, Chuong PTV, Nam NH, Dinh NH. Coronary Artery Bypass Surgery: Evidence-Based Practice. Cardiol Rev 2023:00045415-990000000-00183. [PMID: 38112423 DOI: 10.1097/crd.0000000000000621] [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] [Indexed: 12/21/2023]
Abstract
Coronary artery bypass graft (CABG) surgery remains a pivotal cornerstone, offering established symptomatic alleviation and prognostic advantages for patients grappling with complex multivessel and left main coronary artery diseases. Despite the lucid guidance laid out by contemporary guidelines regarding the choice between CABG and percutaneous coronary intervention (PCI), a notable hesitation persists among certain patients, characterized by psychological reservations, knowledge gaps, or individual beliefs that sway their inclination toward surgical intervention. This comprehensive review critically synthesizes the prevailing guidelines, modern practices, and outcomes pertaining to CABG surgery, delving into an array of techniques and advancements poised to enhance both short-term and enduring surgical outcomes. The exploration encompasses advances in on-pump and off-pump procedures, conduit selection strategies encompassing the bilateral utilization of internal mammary artery and radial artery conduits, meticulous graft evaluation methodologies, and the panorama of minimally invasive approaches, including those assisted by robotic technology. Furthermore, the review navigates the terrain of hybrid coronary revascularization, shedding light on the pivotal roles of shared decision-making and the heart team in shaping treatment pathways. As a comprehensive compendium, this review not only navigates the intricate landscape of CABG surgery but also aligns it with contemporary practices, envisioning its trajectory within the evolving currents of healthcare dynamics.
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Affiliation(s)
- Phan Quang Thuan
- From the Department of Adult Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Pham Tran Viet Chuong
- From the Department of Adult Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nguyen Hoai Nam
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Dinh
- From the Department of Adult Cardiovascular Surgery, University Medical Center, Ho Chi Minh City, Vietnam
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
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Balkhy HH, Nisivaco SM, Hashimoto M, Torregrossa G, Grady K. Robotic Total Endoscopic Coronary Bypass in 570 Patients: Impact of Anastomotic Technique in 2 Eras. Ann Thorac Surg 2021; 114:476-482. [PMID: 34890572 DOI: 10.1016/j.athoracsur.2021.10.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND In coronary bypass grafting, including robotic off-pump totally-endoscopic coronary bypass (TECAB), the anastomotic technique is the most critical part of the procedure. We reviewed results in 570 patients over a 7-year period and compared outcomes between to eras, based on predominant anastomotic technique: connectors versus running suture. METHODS Between 7/2013-12/2020, 570 patients underwent off-pump TECAB. Group-1 (378 patients, 7/2013-8/2018) using predominantly the C-Port Flex ATM distal anastomotic stapler (Aesculap, Tuttlingen Germany), Group-2 (192 patients, 9/2018-12/2020) using predominantly a sutured technique (7-0 PronovaTM, Johnson and Johnson, USA). Retrospective analysis of clinical outcomes was performed. RESULTS Off-pump TECAB was completed in 98.8% (563/570 patients) with an Observed/Expected mortality of 0.6 (6/570 patients). The anastomotic device was used in 89% of 626 grafts in Group-1 and only 11% of 305 grafts in Group-2 (p=0.001). There were no differences in multivessel TECAB (57%vs.53%;p=0.331) or bilateral internal thoracic artery use (50%vs.43%;p=0.127) in Group-1 vs Group-2, respectively. Operative time was shorter in Group-1 (242+84 min vs. 273+88 min;p<0.001). Early clinical outcomes were similar between groups, except for hospital stay which was longer in Group-1 (2.9vs2.3 days;p<0.001). Graft patency was similar (98%vs95%;p=0.295) in Group-1 vs Group-2, respectively. CONCLUSIONS Changing the predominant approach from stapled anastomosis to a sutured technique during robotic TECAB resulted in longer operative times. Both approaches led to excellent outcomes, including graft patency. The shorter operative times conferred by using staplers may flatten the learning curve and facilitate broader adoption of TECAB.
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Affiliation(s)
- Husam H Balkhy
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois.
| | - Sarah M Nisivaco
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Makoto Hashimoto
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Kaitlin Grady
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
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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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Cheng N, Zhang H, Yang M, Liu G, Guo Y, Kang W, Gao C, Wang R. Eleven-year outcomes of U-clips in totally robotic coronary artery bypass grafting versus standard hand-sewn running suture in robotic-assisted coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2021; 33:27-33. [PMID: 33729469 DOI: 10.1093/icvts/ivab053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/13/2020] [Accepted: 01/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical outcomes of patients undergoing off-pump robotic coronary artery bypass grafting (CABG) with either interrupted nitinol U-Clips in totally endoscopic coronary artery bypass (TECAB) or standard running suture anastomosis in robotically assisted direct coronary artery bypass (RADCAB) over a decade. METHODS From January 2007 to December 2017, 280 patients underwent robotic off-pump CABG using the da Vinci S/Si Surgical System in our centre. TECAB with interrupted nitinol U-Clips anastomosis was performed in the left internal mammary artery (LIMA) to LAD grafting in 126 patients and RADCAB (n = 154) of the LIMA to LAD was completed with standard running suture. After discharge, patients were contacted through telephone interview and were invited to attend the outpatient clinic every 6 months or 1 year. The graft patency was assessed by coronary angiography or computed tomography angiography. RESULTS All cases were completed without conversion to median sternotomy or cardiopulmonary bypass. A total of 275 single internal mammary artery (IMA) grafts (271 LIMAs, 4 right internal mammary arteries) and 5 bilateral IMA grafts were used as single graft or composite grafts. All the patients were discharged without in-hospital mortality or adverse outcomes. The average follow-up was 89.7 ± 30.4 months (range, 14-143 months). The cumulative survival rates (P = 0.53), the cumulative IMA patency rates (P = 0.83), and the rates of freedom from major adverse cerebrovascular and cardiovascular events (P = 0.41) between TECAB and RADCAB all showed no significant difference in the follow-up. CONCLUSIONS Robotic off-pump CABG using IMA grafts is safe and can provide reliable long-term outcomes. Compared with the standard hand-sewn running suture technique in RADCAB, interrupted suture with the nitinol U-Clips in TECAB showed similar long-term clinical results and graft patency in LIMA to LAD bypass grafting.
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Affiliation(s)
- Nan Cheng
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Huajun Zhang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Ming Yang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Guopeng Liu
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Yi Guo
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Wenbin Kang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Changqing Gao
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
| | - Rong Wang
- Department of Cardiovascular Surgery, PLA General Hospital, Beijing, China
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Ruttkay T, Bárány L, Grimm A, Patonay L, Petneházy Ö, Rácz G, Baksa G, Galajda Z. A different technique for sutureless coronary bypass grafting. Interv Med Appl Sci 2020; 11:187-192. [PMID: 36343288 PMCID: PMC9467338 DOI: 10.1556/1646.11.2019.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Many coronary anastomotic devices have been designed to replace manual stitching in coronary surgery; however, interestingly, none of them became widespread. Our aim was to work out an easy and fast endoluminal vessel-to-vessel stent bridge distal anastomotic technique. Materials and methods Ten coronary arteries of eight fresh human hearts were used in this study. The anastomosis was performed with the implantation of a graft vessel into the lumen of the coronary artery by performing stent fixation. The technique is described and photo documented in detail. The durability and the conductibility of the anastomosis were examined with intraluminal endoscopy, functional streaming test, and a coloring of the vessels. Results The anastomosis had great results in all cases. Obstruction, dissection, or dislocation of the vessels was not observable. Conclusions This study confirmed the ex-vivo feasibility of the described technique. This method can be an easy, fast, and reliable method applied in the endoscopic distal coronary artery anastomosis surgery. The development of stents adapted to this method and the in-vivo testing of this technique are necessary for the future.
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Affiliation(s)
- Tamás Ruttkay
- 1 Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - László Bárány
- 1 Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - András Grimm
- 1 Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
- 2 Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Lajos Patonay
- 1 Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | | | - Gergely Rácz
- 4 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Gábor Baksa
- 1 Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Zoltán Galajda
- 5 Department of Cardiac Surgery, Central Military Hospital, Bucharest, Romania
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Thijs I, Fresiello L, Oosterlinck W, Sinnaeve P, Rega F. Assessment of Physical Activity by Wearable Technology During Rehabilitation After Cardiac Surgery: Explorative Prospective Monocentric Observational Cohort Study. JMIR Mhealth Uhealth 2019; 7:e9865. [PMID: 30702433 PMCID: PMC6374731 DOI: 10.2196/mhealth.9865] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/13/2018] [Accepted: 12/10/2018] [Indexed: 01/14/2023] Open
Abstract
Background Wearable technology is finding its way into clinical practice. Physical activity describes patients’ functional status after cardiac surgery and can be monitored remotely by using dedicated trackers. Objective The aim of this study was to compare the progress of physical activity in cardiac rehabilitation by using wearable fitness trackers in patients undergoing coronary artery bypass surgery by either the conventional off-pump coronary artery bypass (OPCAB) or the robotically assisted minimally invasive coronary artery bypass (RA-MIDCAB). We hypothesized faster recovery of physical activity after RA-MIDCAB in the first weeks after discharge as compared to OPCAB. Methods Patients undergoing RA-MIDCAB or OPCAB were included in the study. Each patient received a Fitbit Charge HR (Fitbit Inc, San Francisco, CA) physical activity tracker following discharge. Rehabilitation progress was assessed by measuring the number of steps and physical activity level daily. The physical activity level was calculated as energy expenditure divided by the basic metabolic rate. Results A total of 10 RA-MIDCAB patients with a median age of 68 (min, 55; max, 83) years and 12 OPCAB patients with a median age of 69 (min, 50; max, 82) years were included. Baseline characteristics were comparable except for body mass index (RA-MIDCAB: 26 kg/m²; min, 22; max, 28 versus OPCAB: 29 kg/m²; min, 27; max, 33; P<.001). Intubation time (P<.05) was significantly lower in the RA-MIDCAB group. A clear trend, although not statistically significant, was observed towards a higher number of steps in RA-MIDCAB patients in the first week following discharge. Conclusions RA-MIDCAB patients have an advantage in recovery in the first weeks of revalidation, which is reflected by the number of steps and physical activity level measured by the Fitbit Charge HR, as compared to OPCAB patients. However, unsupervised assessment of daily physical activity varied widely and could have consequences with regard to the use of these trackers as research tools.
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Affiliation(s)
- Isabeau Thijs
- Research Unit of Cardiac Surgery, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Libera Fresiello
- Department of Cardiac Surgery, Katholiek Universiteit Leuven, Leuven, Belgium.,Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Wouter Oosterlinck
- Research Unit of Cardiac Surgery, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Peter Sinnaeve
- Research Unit of Cardiology, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Research Unit of Cardiac Surgery, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
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Zubrzycki M, Liebold A, Skrabal C, Reinelt H, Ziegler M, Perdas E, Zubrzycka M. Assessment and pathophysiology of pain in cardiac surgery. J Pain Res 2018; 11:1599-1611. [PMID: 30197534 PMCID: PMC6112778 DOI: 10.2147/jpr.s162067] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Analysis of the problem of surgical pain is important in view of the fact that the success of surgical treatment depends largely on proper pain management during the first few days after a cardiosurgical procedure. Postoperative pain is due to intraoperative damage to tissue. It is acute pain of high intensity proportional to the type of procedure. The pain is most intense during the first 24 hours following the surgery and decreases on subsequent days. Its intensity is higher in younger subjects than elderly and obese patients, and preoperative anxiety is also a factor that increases postoperative pain. Ineffective postoperative analgesic therapy may cause several complications that are dangerous to a patient. Inappropriate postoperative pain management may result in chronic pain, immunosuppression, infections, and less effective wound healing. Understanding and better knowledge of physiological disorders and adverse effects resulting from surgical trauma, anesthesia, and extracorporeal circulation, as well as the development of standards for intensive postoperative care units are critical to the improvement of early treatment outcomes and patient comfort.
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Affiliation(s)
- Marek Zubrzycki
- Department of Cardiac Surgery, University of Ulm Medical Center, Ulm, Germany,
| | - Andreas Liebold
- Department of Cardiac Surgery, University of Ulm Medical Center, Ulm, Germany,
| | - Christian Skrabal
- Department of Cardiac Surgery, University of Ulm Medical Center, Ulm, Germany,
| | - Helmut Reinelt
- Department of Cardiac Anesthesiology, University of Ulm Medical Center, Ulm, Germany
| | - Mechthild Ziegler
- Department of Cardiac Anesthesiology, University of Ulm Medical Center, Ulm, Germany
| | - Ewelina Perdas
- Department of Cardiovascular Physiology, Medical University of Lodz, Lodz, Poland
| | - Maria Zubrzycka
- Department of Cardiovascular Physiology, Medical University of Lodz, Lodz, Poland
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Novel Dry-Lab Training Method for Totally Endoscopic Coronary Anastomosis: A Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:363-369. [PMID: 29028652 DOI: 10.1097/imi.0000000000000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We describe our original dry-lab training system for nonrobotic and beating heart endoscopic coronary artery anastomosis. METHODS All the materials used for this training were commercially available. We selected a boxed machine, which can produce pulsatile movements of artificial vessels, and on its roof, we installed a two-dimensional home video camera and a monitor. A multiple-holed plate was placed in front of the machine, and through these holes, a trainee inserted endoscopic surgical instruments and anastomosed the artificial vessels by running fashion while watching the monitor. This training program has four stages. During the first stage, a trainee has to demonstrate mastery in conducting a conventional off-pump coronary artery anastomosis without assistance. The second stage is the "nonbeating" version, and the third stage is the "beating" version with the model mentioned previously. After a trainee gets accustomed to the third stage, the original artificial vessel is replaced with an extremely fragile one, and this is the fourth stage. Our trainee conducted one hundred fourth-stage anastomoses and each procedure was recorded with the video camera. We analyzed several factors from the videos and evaluated the efficacy of the training method. We compared the outcomes of the first 50 consecutive anastomoses with the following 50 ones and described the learning curves. RESULTS The comparison showed a significant decrease in anastomotic time and vessel injury. We considered the quality of anastomosis acceptable after 47 anastomoses, and anastomotic time fell below 15 minutes at the 81st training at the fourth stage. CONCLUSIONS Our dry-lab system might be an effective training method for endoscopic coronary anastomosis.
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Ujihira K, Yamada A. Novel Dry-Lab Training Method for Totally Endoscopic Coronary Anastomosis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kosuke Ujihira
- From the Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Akira Yamada
- From the Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan
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Yang M, Xiao LB, Gao ZS, Zhou JW. Clinical Effect and Prognosis of Off-Pump Minimally Invasive Direct Coronary Artery Bypass. Med Sci Monit 2017; 23:1123-1128. [PMID: 28257412 PMCID: PMC5347985 DOI: 10.12659/msm.902940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Coronary artery bypass grafting (CABG) is a common procedure to circumvent the obstruction of coronary arteries when stents are unsuitable. CABG is a very traumatic surgery that requires redirecting blood flow to an external pump. Thus, this procedure has many risks during and after surgery, and minimizing these risks would greatly benefit the patients. Material/Methods We selected 126 patients with coronary artery syndrome and who were unsuitable for stent percutaneous coronary intervention. The observation group received minimally invasive direct coronary artery bypass (MIDCAB), while the control group was treated with off-pump CABG. Results Blood markers and echocardiography before and after treatment improved equally in both groups. Neither group exhibited obvious adverse reactions, or liver and kidney function damage. However, surgical bleeding and postoperative observation days were significantly reduced in the MIDCAB group. Death and cardiac shock at the end of follow-up were significantly lower in the MIDCAB group. Conclusions Overall, the clinical benefits of MIDCAB and OP-CABG were similar, but MIDCAB significantly reduced postoperative hospital stay and intraoperative blood transfusion, and improved clinical prognosis.
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Affiliation(s)
- Ming Yang
- Department of Cardiothoracic Surgery, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Lian-Bo Xiao
- Department of Cardiothoracic Surgery, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Zhi-Sheng Gao
- Department of Cardiovascular Internal Four, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Ji-Wu Zhou
- Department of Cardiothoracic Surgery, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
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Bruno P, Perri G, Massetti M. Hybrid treatment: the left anterior descendant artery to the surgeon - all the rest to the interventional cardiologist. J Cardiovasc Med (Hagerstown) 2016; 18 Suppl 1:e141-e144. [PMID: 27898503 DOI: 10.2459/jcm.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Piergiorgio Bruno
- Cardiosurgery Unit, Policlinico Agostino Gemelli Foundation, Rome, Italy
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