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Sellin C, Sand U, Demianenko V, Schmitt C, Schäfer B, Schier R, Doerge H. Comparison of Pulmonary Outcome in Minimally Invasive (TCRAT) and Full Sternotomy CABG. Thorac Cardiovasc Surg 2024. [PMID: 39095028 DOI: 10.1055/a-2378-8459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND Pulmonary complications are among the main causes of increased mortality, and morbidity, as well as prolonged intensive care unit (ICU) and hospital stay after cardiac surgery. Recently, a sternum-sparing concept of minimally invasive total coronary revascularization via anterior minithoracotomy (TCRAT) was introduced. A higher risk of pulmonary injury could be anticipated due to the thoracic incision and the longer duration of surgery. Pulmonary complications in TCRAT were compared to standard coronary artery bypass grafting (CABG) via full median sternotomy (FS). METHODS Records of 151 consecutive TCRAT (from September 2021 to November 2022) and 229 consecutive FS patients (from January 2017 to December 2018) patients, who underwent elective or urgent CABG, were analyzed. Preoperative baseline characteristics (age, sex, body mass index, diabetes, hypertension, chronic obstructive pulmonary disease, smoking status, left ventricular ejection fraction, pulmonary hypertonus, and EuroScore II) were comparable between groups. RESULTS Differences between examined groups examined were found for the pulmonary parameters: Horowitz index 6 hours after operation (TCRAT 270 ± 72 vs. FS 293 ± 73, p < 0.05), pneumothorax (TCRAT 0% vs. FS 2.6%, p < 0.05), bronchoscopies (TCRAT 5.9% vs. FS 1.7%, p < 0.05), and pleural effusion (TCRAT 8.6% vs. FS 3.5%, p < 0.05). Moreover, there were differences between groups with regard to mean ICU stay (TCRAT 2.4 ± 3.0 days vs. FS 1.8 ± 1.8 days, p < 0.05), stroke (TCRAT 0% vs. FS 1.3%, p < 0.05), and hospital stay (TCRAT 10.9 ± 8.5 days vs. FS 13.2 ± 9.3 days, p < 0.05). There were no differences regarding atelectasis, reintubations, tracheostomies, ventilation time, and mortality. CONCLUSION Pulmonary complications in terms of pleural effusions were more common with TCRAT, however, without substantial impact on clinical outcome.
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Affiliation(s)
- Christian Sellin
- Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda gAG, Hessen, Germany
| | - Ulrike Sand
- Department of Anaesthesiology, Klinikum Fulda gAG, Fulda, Hessen, Germany
| | - Volodymyr Demianenko
- Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda gAG, Hessen, Germany
| | - Christoph Schmitt
- Department of Anaesthesiology, Klinikum Fulda gAG, Fulda, Hessen, Germany
| | - Benedikt Schäfer
- Department of Anaesthesiology, Klinikum Fulda gAG, Fulda, Hessen, Germany
| | - Robert Schier
- Department of Anaesthesiology, Klinikum Fulda gAG, Fulda, Hessen, Germany
| | - Hilmar Doerge
- Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda gAG, Hessen, Germany
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Sellin C, Belmenai A, Niethammer M, Schächinger V, Dörge H. Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomy. JTCVS Tech 2024; 26:52-60. [PMID: 39156523 PMCID: PMC11329208 DOI: 10.1016/j.xjtc.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 08/20/2024] Open
Abstract
Objective A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy demonstrated promising early outcomes in unselected patients with coronary artery multivessel disease. Follow-up data are still missing. Methods From November 2019 to September 2023, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed as a routine procedure in 392 consecutive, nonemergency patients (345 men; 67.0 ± 9.9 years; range, 32-88 years). All patients had multivessel coronary artery disease (77.6% 3-vessel-disease, 22.4% 2-vessel-disease, and 32.9% left main stenosis). Patients at old age (older than a 80 years, 12.5%), with severe left ventricular dysfunction (ejection fraction <30%, 7.9%), diabetes mellitus (34.9%), massive obesity (body mass index > 35, 8.9%), and chronic lung disease (17.1%) were included. Mean European System for Cardiac Operative Risk Evaluation II score was 2.9 ± 2.8. Mean midterm follow-up (100%) was 15.2 ± 10.7 months (range, 0.1-39.5 months). Results Left internal thoracic artery (99.0%), radial artery (70.4%), and saphenous vein grafts (57.4%) were used, and 70.4% of patients received at least 2 arterial grafts. A total of 3.0 ± 0.8 anastomoses (range, 2-5 anastomoses) per patient were performed to revascularize the territories of left anterior descending (98.7%), circumflex (91.6%), and right coronary (70.9%) artery. Complete anatomical revascularization was achieved in 95.1%. At follow-up, all-cause-mortality, myocardial infarction, repeat revascularization, and stroke was 3.1%, 1.5%, 5.4%, and 0.7%, respectively. Overall major adverse cardiac and cerebrovascular events rate was 8.7%. Conclusions This is the first report of midterm follow-up after routine sternum-sparing total coronary revascularization via left anterior thoracotomy for multivessel coronary artery disease with a high rate of multiple arterial grafting and complete anatomical revascularization. Outcome was favorable and similar to that of contemporary conventional coronary artery bypass grafting.
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Affiliation(s)
- Christian Sellin
- Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, Germany
| | - Ahmed Belmenai
- Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, Germany
| | - Margit Niethammer
- Department of Cardiology, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, Germany
| | - Volker Schächinger
- Department of Cardiology, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, Germany
| | - Hilmar Dörge
- Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, Germany
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Ushioda R, Hirofuji A, Yoongtong D, Sakboon B, Cheewinmethasiri J, Lokeskrawee T, Patumanond J, Lawanaskol S, Kamiya H, Arayawudhikul N. Multi-vessel coronary artery grafting: analyzing the minimally invasive approach and its safety. Front Cardiovasc Med 2024; 11:1391881. [PMID: 38774658 PMCID: PMC11106462 DOI: 10.3389/fcvm.2024.1391881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/18/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction At our institution, we perform off-pump coronary artery bypass (OPCAB) as a standard procedure. Moreover, patients with favorable coronary anatomy and condition are selected for minimally invasive cardiac surgery (MICS)-OPCAB. We retrospectively compared early outcomes, focusing on safety, between MICS-OPCAB and conventional off-pump techniques for multivessel coronary artery bypass grafting (CABG). Methods From August 2017 to September 2022, 1,220 patients underwent multivessel coronary artery grafting at our institution. They were divided into the MICS-OPCAB group (MICS group = 163 patients) and the conventional OPCAB group (MS group = 1057 patients). Propensity score matching (1 : 1 ratio) was applied to the MICS-OPCAB and MS groups (149 patients per group) based on 23 preoperative clinical characteristics. Results After matching, there were no significant differences in preoperative characteristics between the groups. The MICS group had a lower total graft number (2.3 ± 0.6 vs. 2.9 ± 0.8, p < 0.001) and fewer distal anastomoses (2.7 ± 0.8 vs. 3.2 ± 0.9, p < 0.001). There were no significant differences in hospital stay, intensive care unit stay, postoperative complications, and 30-day mortality. The MICS group had less drain output (MICS 350 ml [250-500], MS 450 ml [300-550]; p = 0.013). Kaplan-Meier analysis revealed no significant differences in postoperative MACCE (major adverse cardiac or cerebrovascular events)-free and survival rates between the groups (MACCE-free rate p = 0.945, survival rate p = 0.374). Conclusion With proper patient selection, MICS-OPCAB can provide good short to mid-term results, similar to those of conventional OPCAB.
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Affiliation(s)
- Ryohei Ushioda
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, Thailand
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Aina Hirofuji
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Dit Yoongtong
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, Thailand
| | - Boonsap Sakboon
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, Thailand
| | - Jaroen Cheewinmethasiri
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, Thailand
| | | | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Nuttapon Arayawudhikul
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, Lampang Hospital, Lampang, Thailand
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Marinakis S, Homsy K, Nakadi BE. Evolution of Surgical Expertise in Endoscopic Assisted Minimally Invasive Coronary Artery Bypass: Experience With 70 Consecutive Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241237482. [PMID: 38576097 DOI: 10.1177/15569845241237482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
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Arslanhan G, Özcan ZS, Şenay Ş, Baştopçu M, Koçyiğit M, Değirmencioğlu A, Alis D, Alhan C. Robot-Assisted Minimally Invasive Multivessel Coronary Bypass Guided by Computerized Tomography. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:30-38. [PMID: 38111997 DOI: 10.1177/15569845231213038] [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] [Indexed: 12/20/2023]
Abstract
OBJECTIVE Robot-assisted minimally invasive coronary bypass surgery is one of the least invasive approaches that offers multivessel revascularization and accelerated recovery. We investigated the benefits of computed tomography angiography (CTA) guidance in robotic coronary bypass (RCAB) by analyzing perioperative outcomes. METHODS Between April 2022 and April 2023, 60 consecutive patients who underwent RCAB under preoperative CTA guidance were included. The intercostal space of the minithoractomy incision was determined based on the distance from the thoracotomy site to the midsection of the left anterior descending artery (LAD) on preoperative CTA. Peripheral vascular findings on preoperative CTA guided the decision for the cannulation site. Perioperative parameters and early outcomes were evaluated. RESULTS The mean age of the patients was 62.3 ± 10.5 years, and 51 patients were male (85.0%). The mean number of revascularized vessels was 2.9 ± 1.1. Left thoracotomy guided by CTA measurements was performed in the fourth intercostal space in 37 patients (61.7%) and in the third intercostal space in the remaining patients. Axillary cannulation was performed in 28 (46.7%) patients because of prohibitive findings in the iliac vessels and aorta. All target coronary arteries with an indication for bypass were revascularized with CTA-guided RCAB. The left internal mammary artery (LIMA) was anastomosed to the LAD in all patients, and the LIMA was anastomosed sequentially to the diagonal artery in 17 patients (28.3%). No operative mortality or cerebrovascular event was observed. One patient underwent reoperation due to bleeding. CONCLUSIONS Robot-assisted minimally invasive multiple-vessel coronary bypass under preoperative CTA guidance is safe and can be performed with excellent results.
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Affiliation(s)
- Gökhan Arslanhan
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Zeynep Sıla Özcan
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Şahin Şenay
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Murat Baştopçu
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Research and Training Hospital, Istanbul, Turkey
| | - Muharrem Koçyiğit
- Department of Anesthesiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Aleks Değirmencioğlu
- Department of Cardiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
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Sellin C, Belmenai A, Asch S, Voß M, Dörge H. Novel concept of less invasive concomitant surgical aortic valve replacement and coronary artery bypass grafting avoiding full median sternotomy. Heart Vessels 2023; 38:1298-1303. [PMID: 37393381 DOI: 10.1007/s00380-023-02281-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
In the last decades, minimally invasive procedures have been developed in the therapy of aortic valve disorders. Recently, a novel concept of minimally invasive coronary revascularization in multivessel disease via left anterior mini-thoracotomy demonstrated promising results. Full median sternotomy, as a very invasive procedure, is the standard approach in concomitant surgical aortic valve replacement (sAVR) and coronary bypass grafting (CABG). The aim of our study was to show that the combination of minimal invasive aortic valve replacement via upper mini-sternotomy and coronary artery bypass grafting via left anterior mini-thoracotomy is feasible to avoid full median sternotomy. From 07/2022 to 09/2022, concomitant sAVR via upper partial sternotomy and CABG via left anterior mini-thoractomy on cardiopulmonary bypass and cardioplegic arrest was successfully performed in six consecutive patients (6 males; 69.8 ± 7.4 [60-79] years). All patients had severe aortic stenosis (MPG 45.5 ± 17.3 mmHg) and a significant coronary artery disease (three-vessel: 33%, two-vessel: 33%, one-vessel: 33%) with indication to cardiac surgery. Mean EuroScore2 was 3.2. All patients underwent successful less invasive concomitant biological sAVR and CABG. 67% of patients received a 25 mm, 33% received a 23 mm biological aortic valve replacement (Edwards Lifesciences Perimount). A total of 11 distal anastomoses (1.8 ± 1.0 [1-3] per patient) were performed by using left internal artery mammary (50%), radial artery (17%) and saphenous venous graft (67%) for grafting the left anterior descending (83%), circumflex (67%) and right (33%) coronary artery. Hospital mortality was 0%, stroke rate was 0%, myocardial infarction was 0% and repeat revascularization rate was 0%, ICU stay was 1 day in 83% of all patients and 50% left hospital within 8 days after surgery. Less invasive concomitant surgical aortic valve replacement and coronary artery bypass grafting using upper mini-sternotomy and left anterior mini-thoracotomy is feasible without compromises in surgical principles and complete coronary revascularization while maintaining thoracic stability by avoiding full median sternotomy.
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Affiliation(s)
- Christian Sellin
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany.
| | - Ahmed Belmenai
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany
| | - Silke Asch
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany
| | - Meinolf Voß
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany
| | - Hilmar Dörge
- Department of Cardiothoracic Surgery, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Germany
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Faerber G, Mukharyamov M, Doenst T. Is There a Future for Minimal Access and Robots in Cardiac Surgery? J Cardiovasc Dev Dis 2023; 10:380. [PMID: 37754809 PMCID: PMC10531980 DOI: 10.3390/jcdd10090380] [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: 07/31/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Minimally invasive techniques in cardiac surgery have found increasing use in recent years. Both patients and physicians often associate smaller incisions with improved outcomes (i.e., less risk, shorter hospital stay, and a faster recovery). Videoscopic and robotic assistance has been introduced, but their routine use requires specialized training and is associated with potentially longer operating times and higher costs. Randomized evidence is scarce and transcatheter treatment alternatives are increasing rapidly. As a result, the concept of minimally invasive cardiac surgery may be viewed with skepticism. In this review, we examine the current status and potential future perspectives of minimally invasive and robotic cardiac surgery.
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Affiliation(s)
| | | | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, 07747 Jena, Germany
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Kyaruzi M, Gülmez H, Demirsoy E. Can Minimally Invasive Multivessel Coronary Revascularization Be a Routine Approach? Thorac Cardiovasc Surg 2023; 71:455-461. [PMID: 35644133 DOI: 10.1055/s-0042-1749209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Advancement in the field of cardiovascular surgery has emerged with various minimally invasive approaches for the treatment of multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. This study describes our routine technical approach and clinical experience of minimally invasive coronary artery bypass via left anterior minithoracotomy for the treatment of patients with multivessel coronary lesions. METHODS Our experience includes 100 consecutive patients who were operated between July 2020 and April 2021. The left internal thoracic artery was harvested in all patients. Radial arterial grafts and saphenous vein grafts were harvested endoscopically. Patients were operated either under cardiopulmonary bypass (CPB) with blood cardioplegia through left anterior minithoracotomy of 5 to 7 cm or off-pump via left anterolateral minithoracotomy. RESULTS We had single mortality (1%), no early postoperative myocardial infarction was observed. None of our patients was converted to sternotomy (0%). The mean number of bypass was 3.1 ± 0.8, the mean cross-clamping time was 78.1 ± 20.6 minutes, the mean CPB time was 153.2 ± 37.5 minutes, the average intubation time was 6.33 ± 11.29 hours, the mean intensive care unit stay was 1.62 ± 1.78 days, the mean hospital stay was 4.98 ± 3.01 days, the average total operation time was 4.20 ± 0.92 hours, and the average pleural drain was 393.8 ± 169.7 mL. CONCLUSION Minimally invasive coronary artery bypass grafting via left anterior minithoracotomy can be routinely performed with safety and it is feasible, reproducible with a short learning curve. Further multicenter studies are needed for the standardization of our technique.
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Affiliation(s)
- Mugisha Kyaruzi
- Department of Cardiovascular Surgery, Liv Hospital, Bahçeşehir, Istinye University, Istanbul, Turkey
| | | | - Ergun Demirsoy
- Department of Cardiovascular Surgery, Kolan Hospital Group, Istanbul, Turkey
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Sellin C, Asch S, Belmenai A, Mourad F, Voss M, Dörge H. Early Results of Total Coronary Revascularization via Left Anterior Thoracotomy. Thorac Cardiovasc Surg 2023; 71:448-454. [PMID: 36368676 PMCID: PMC10480014 DOI: 10.1055/s-0042-1758149] [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: 05/22/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Avoidance of sternotomy while preserving complete revascularization remains challenging in multivessel coronary disease. Technical issues and in-hospital outcomes of total coronary revascularization via a small left anterior thoracotomy (TCRAT) in nonselected patients with multivessel disease are reported. METHODS From November 2019 to September 2021, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed in 102 patients (92 males; 67 ± 10 [42-87] years). Slings were placed around ascending aorta, left pulmonary veins, and inferior vena cava for exposure of lateral and inferior ventricular wall. All patients had multivessel coronary disease (three-vessel disease: n = 72; two-vessel disease: n = 30; left main stenosis: n = 44). We included patients at old age (> 80 years, 14.7%), with severe left ventricular dysfunction (ejection fraction < 30%, 6.9%), massive obesity (body mass index > 35, 11.6%), and at increased risk (EuroSCORE II > 4, 15.7%). RESULTS Left internal thoracic artery (n = 101), radial artery (n = 83), and saphenous vein (n = 39) grafts were used for total (61.8%) or multiple (19.6%) arterial grafting. A total of 323 distal anastomoses (3.2 ± 0.7 [2-5] per patient) were performed to revascularize left anterior descending (100%), circumflex (91.2%), and right coronary artery (67.7%). Complete revascularization was achieved in 95.1%. In-hospital mortality was 2.9%, stroke rate was 1.0%, myocardial infarction rate was 2.9%, and repeat revascularization rate was 2.0%. CONCLUSION This novel surgical technique allows complete coronary revascularization in the broad majority of multivessel disease patients without sternotomy. TCRAT can be introduced into clinical routine safely. Long-term results remain to be investigated.
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Affiliation(s)
- Christian Sellin
- Klinik für Herz- und Thoraxchirurgie, Klinikum Fulda gAG, Fulda, Germany
| | - Silke Asch
- Klinik für Herz- und Thoraxchirurgie, Klinikum Fulda gAG, Fulda, Germany
| | - Ahmed Belmenai
- Klinik für Herz- und Thoraxchirurgie, Klinikum Fulda gAG, Fulda, Germany
| | - Fanar Mourad
- Klinik für Herz- und Thoraxchirurgie, Klinikum Fulda gAG, Fulda, Germany
| | - Meinolf Voss
- Klinik für Herz- und Thoraxchirurgie, Klinikum Fulda gAG, Fulda, Germany
| | - Hilmar Dörge
- Klinik für Herz- und Thoraxchirurgie, Klinikum Fulda gAG, Fulda, Germany
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Babliak O, Demianenko V, Marchenko A, Babliak D, Melnyk Y, Stohov O, Revenko K, Pidgayna L. Left anterior minithoracotomy as a first-choice approach for isolated coronary artery bypass grafting and selective combined procedures. Eur J Cardiothorac Surg 2023; 64:ezad182. [PMID: 37144954 DOI: 10.1093/ejcts/ezad182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/23/2023] [Accepted: 05/04/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES Our goal was to describe the technique for and evaluate the results of the isolated coronary artery bypass grafting or combined grafting procedures with mitral valve repair/replacement and/or left ventricle aneurysm repair performed through a single left anterior minithoracotomy. METHODS Perioperative data of all patients who required isolated or combined coronary grafting from July 2017 to December 2021 were observed. The focus was on 560 patients who underwent isolated or combined multivessel coronary bypass using the "Total Coronary Revascularization via left Anterior Thoracotomy" technique. The main perioperative outcomes were analysed. RESULTS A left anterior minithoracotomy was used in 521 (97.7%) out of 533 patients who required isolated multivessel surgical coronary revascularization and in 39 (32.5%) out of 120 patients who required combined procedures. In 39 patients, multivessel grafting was combined with 25 mitral valve and 22 left ventricular procedures. Mitral valve repair was performed through the aneurysm (n = 8) or through the interatrial septum (n = 17). Perioperative outcomes in isolated and combined groups were next: aortic cross-clamp time-71.9 (SD: 19.9) and 120 (SD: 25.8) min; cardiopulmonary bypass time-145.7 (SD: 33.5) and 216 (SD: 45.8) min; total operating time-269 (SD: 51.8) and 324 (SD: 52.1) min; intensive care unit stay-2 (2-2) and 2 (2-2) days; total hospital stay-6 (5-7) and 6 (5-7) days; and total 30-day mortality was 0.54 and 0%, respectively. CONCLUSIONS A left anterior minithoracotomy can be effectively used as a first-choice approach to perform isolated multivessel coronary grafting and can be combined with mitral valve and/or left ventricular repair. Experience with isolated coronary grafting through an anterior minithoracotomy is required to achieve the satisfactory results in combined procedures.
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Affiliation(s)
- Oleksandr Babliak
- Diagnostic and Treatment Center for Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine
| | - Volodymyr Demianenko
- Diagnostic and Treatment Center for Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine
| | - Anton Marchenko
- Diagnostic and Treatment Center for Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine
| | - Dmytro Babliak
- Diagnostic and Treatment Center for Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine
| | - Yevhenii Melnyk
- Diagnostic and Treatment Center for Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine
| | - Oleksii Stohov
- Diagnostic and Treatment Center for Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine
| | - Katerina Revenko
- Diagnostic and Treatment Center for Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine
| | - Liliya Pidgayna
- Diagnostic and Treatment Center for Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine
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Babliak O. Predictors and outcomes of conversion to sternotomy in minimally invasive CABG. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:169-170. [PMID: 37484644 PMCID: PMC10357867 DOI: 10.5606/tgkdc.dergisi.2023.98552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Oleksandr Babliak
- Department of Cardiac Surgery, Dobrobut Medical Network, Sim'i Idzikhovskyh, Kyiv, Ukraine
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Novel concept of routine total arterial coronary bypass grafting through a left anterior approach avoiding sternotomy. Heart Vessels 2022; 37:1299-1304. [PMID: 35122494 PMCID: PMC9239964 DOI: 10.1007/s00380-022-02034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022]
Abstract
Coronary artery bypass grafting (CABG) via full sternotomy remains a very invasive procedure, often requiring prolonged recovery of the patient. We describe a novel, less invasive approach for totally arterial CABG via a small left anterior thoracotomy in a pilot series of 20 unselected patients. From January to March 2020, 20 consecutive patients (mean age 65.9 ± 9.2 years, 100% male, STS-score: 1.6 ± 2) underwent CABG using only arterial conduits via a small left anterior thoracotomy. Patients were operated on cardiopulmonary bypass with peripheral cannulation and transthoracic aortic cross-clamping. Pulling tapes encircling the great vessels, the arrested empty heart was rotated and moved within the pericardium to enable conventional anastomotic techniques especially on lateral and inferior wall coronary targets. In all patients, left internal mammary artery and radial artery were utilized for bypass with 3.3 ± 0.7 distal coronary anastomoses per patient. Anterior, lateral, and inferior wall territories were revascularized in 100%, 85%, and 70% of patients, respectively. Complete anatomical revascularization was achieved in 95% of patients. ICU stay was 1 day in 17 patients, and 14 of patients left the hospital within 8 days. There was no hospital death, no stroke, no myocardial infarction, and no repeat revascularization. In this pilot series of 20 patients, minimally invasive, totally arterial CABG with avoidance of sternotomy was technically feasible with favorable patient outcomes.
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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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Imasaka KI, Onzuka T, Nomura R, Fukuda T, Hirata Y, Morita S, Shiose A. Coronary artery bypass grafting via manubrium-sparing sternotomy in a patient with total laryngectomy and a permanent tracheostoma. Indian J Thorac Cardiovasc Surg 2022; 38:398-402. [DOI: 10.1007/s12055-021-01309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
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Kyaruzi M, Demirsoy E. Minimal invasive approach of post-MI ventricular septal defect repair and coronary artery revascularization via left anterior minithoracotomy. J Card Surg 2021; 36:4808-4810. [PMID: 34549458 DOI: 10.1111/jocs.16012] [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: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022]
Abstract
A 54-year-old male was admitted to our hospital with a prolonged dypsnea, orthopnoea, and chest pain that has lasted for almost 2 weeks. Physical examination revealed symptoms of heart failure. Transthoracic echocardiography revealed a ventricular septal defect located at the apical segment of the interventricular septum, mild mitral regurgitation, and hypokinesia of the apex of the left ventricle. Coronary angiography showed a critical proximal lesion of the left anterior descending artery. He was diagnosed with postmyocardial infarction ventricular septal defect. Our patient underwent minimal invasive coronary artery bypass and ventricular septal defect repair via left anterior minithoracotomy. Postoperative period was uneventful and our patient was released on a postoperative Day 7. Postoperative transthoracic echocardiography revealed no residue of repaired ventricular septal defect with improved left ventricular functions.
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Affiliation(s)
- Mugisha Kyaruzi
- Department of Cardiovascular Surgery, Kolan Hospital Group, Şişli, Istanbul, Turkey
| | - Ergun Demirsoy
- Department of Cardiovascular Surgery, Kolan Hospital Group, Şişli, Istanbul, Turkey
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Bonatti J, Wallner S, Crailsheim I, Grabenwöger M, Winkler B. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J Thorac Dis 2021; 13:1922-1944. [PMID: 33841980 PMCID: PMC8024818 DOI: 10.21037/jtd-20-1535] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra- and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.
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Affiliation(s)
- Johannes Bonatti
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Stephanie Wallner
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Ingo Crailsheim
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Bernhard Winkler
- Department of Cardiac and Vascular Surgery, Vienna Health Network, Clinic Floridsdorf and Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
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Multivessel coronary artery revascularization through left mini-anterior thoracotomy. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:557-559. [PMID: 32953225 DOI: 10.5606/tgkdc.dergisi.2020.19279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022]
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Babliak O, Demianenko V, Melnyk Y, Revenko K, Babliak D, Stohov O, Pidgayna L. Multivessel Arterial Revascularization via Left Anterior Thoracotomy. Semin Thorac Cardiovasc Surg 2020; 32:655-662. [PMID: 32114114 DOI: 10.1053/j.semtcvs.2020.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/11/2022]
Abstract
To present the technique and to evaluate the outcomes of the multivessel minimally invasive coronary revascularization through the left anterior thoracotomy. From July 2017 to March 2019 in 229 consecutive patients with isolated multivessel coronary artery disease we performed complete coronary revascularization through the left anterior minithoracotomy (6-8 cm skin incision). In 47 of them we performed multiarterial revascularization using left internal mammary artery and T-shunt with left radial artery or right internal mammary artery. Cardiopulmonary bypass (CPB), Chitwood clamp and blood cardioplegia were used in all patients. Heart strings, encircling tapes and Chitwood clamp were used to reduce the distance from skin to coronary targets. Usual coronary instruments were used. The perioperative outcomes of multiarterial graft strategy group were compared with uniarterial graft strategy group. There were no mortality, no perioperative myocardial infarcts, and no conversion to sternotomy with either graft strategy groups. The mean number of distal anastomoses, CPB time, and total hospital stay were not different between the groups. Aortic cross-clamp time ((83.8 ± 17.4 (45;121) vs 67.8 ± 17.4 (35;146), P < 0.0001) and total operation time (283.5 ± 45 (205;495) vs 254.3 ± 48.6 (175;590), P = 0.0003) were longer in patients with multiarterial revascularization compared to uniarterial revascularization using left internal mammary artery and veins. Multivessel coronary bypass grafting using CPB and cardioplegia can be routinely performed minimally invasively through the left anterior thoracotomy. In selected patients multiarterial revascularization could be done with excellent procedural outcomes.
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Affiliation(s)
| | | | - Yevhenii Melnyk
- Cardiac Surgery Center, Medical Network Dobrobut, Kyiv, Ukraine
| | | | - Dmytro Babliak
- Cardiac Surgery Center, Medical Network Dobrobut, Kyiv, Ukraine
| | - Oleksii Stohov
- Cardiac Surgery Center, Medical Network Dobrobut, Kyiv, Ukraine
| | - Liliya Pidgayna
- Cardiac Surgery Center, Medical Network Dobrobut, Kyiv, Ukraine
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