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Cain MT, Joyce DL, Szabo A, Wu R, Kohmoto T, Joyce LD, Pearson PJ. Reduced Morbidity and Mortality Associated With Minimally Invasive Single-vessel Coronary Artery Bypass Compared With Conventional Sternotomy. Ann Surg 2023; 277:e1176-e1183. [PMID: 35797604 DOI: 10.1097/sla.0000000000005511] [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: 11/25/2022]
Abstract
OBJECTIVE We aimed to describe the safety and clinical benefits of minimally invasive, nonsternotomy coronary artery bypass grafting (MICABG) using data from The Society of Thoracic Surgeons (STS) National Database. BACKGROUND MICABG has gained popularity, owing to expected lower perioperative morbidity and shorter recovery. Despite this, concerns remain regarding anastomotic quality and the validity of proposed perioperative benefits. METHODS We queried the STS National Database for all patients who underwent single-vessel coronary artery bypass grafting (CABG) from January 2014 to December 2016 to compare outcomes of MICABG with conventional CABG. Patients who underwent concomitant or emergent procedures were excluded. Propensity-weighted cohorts were compared by operative approach with adjustment for variability across institutions. RESULTS Of 12,406 eligible patients, 2688 (21.7%) underwent MICABG, and 9818 (78.3%) underwent conventional CABG. Propensity weighting produced excellent balance in patient characteristics, including completeness of revascularization, body mass index, and STS predictive risk scores. MICABG was associated with significant reduction of in-hospital mortality [odds ratio (OR)=0.32, absolute reduction (AR)=0.91%, P <0.0001]; 30-day mortality (OR=0.51, AR=0.88%, P =0.001), duration of ventilation (8.62 vs 12.6 hours, P <0.0001), prolonged hospitalization (OR=0.77, AR=1.6, P =0.043), deep wound infection (OR=0.33, AR=0.68, P <0.004), postoperative transfusions (OR=0.52, AR=7.7%, P <0.0001), and STS composite morbidity (OR=0.72, AR=1.19%, P =0.008). Subgroup analysis of only off-pump left internal mammary artery-left anterior descending CABG showed similar findings. Major adverse cardiac events and graft occlusion did not differ between groups. CONCLUSIONS MICABG is associated with lower mortality and perioperative morbidity compared with conventional sternotomy CABG. MICABG may have a role in treating single-vessel disease.
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Affiliation(s)
- Michael T Cain
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - David L Joyce
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Ruizhe Wu
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Takushi Kohmoto
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Lyle D Joyce
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Paul J Pearson
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
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Yang D, Zhang K, Li J, Wei D, Ma J, Wang Y, Yang Y, Li J, Bai Y, Zhang Y, Gao J, Wang L. Ninety-seven cases of experiences with the left thoracotomy approach for off-pump conventional revascularization: a retrospective cohort study. J Thorac Dis 2022; 14:3915-3923. [PMID: 36389332 PMCID: PMC9641355 DOI: 10.21037/jtd-22-1162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive coronary surgery-coronary artery bypass grafting (MICS CABG) is well adopted in clinical practice. However, this procedure did not really achieve conventional complete revascularization. The present study aimed to explore the feasibility and safety of conventional revascularization via the left thoracotomy (8-10 cm) approach. METHODS From January 2020 to March 2022, a total of 97 consecutive patients who needed coronary artery revascularization were operated on using this technique. The patients' preoperative, intraoperative, postoperative, and follow-up data were collected. Perioperative variables were compared between the single graft and non-single graft groups. All patients received dual-source computerized tomographic angiography at 1-week postoperatively to evaluate the graft patency and detect pulmonary embolism and aortic dissection. The patients were followed up for 3-27 months. RESULTS The mean age of the entire cohort was 61.5±8.8 years, there were 16 (16.5%) female patients, and 1-4 grafts were performed per patient. There were no conversions to median sternotomy or on-pump CABG. The average number of grafts was 1.9±0.9, and that of the non-single graft group was 2.5±0.6. Among the 97 included patients, one patient in the single graft group suffered from aspiration pneumonia after a stroke and died. The 30-day mortality was 1.0% (one patient), one patient required re-exploration for bleeding (1.1%), and a total of 191 grafts were performed. All grafts were unobstructed except for one graft to the obtuse marginal branch (OM) (0.5%). Follow-up was performed by phone or via outpatient visits and was available for 92 patients (95%). During the follow-up period, 1 (1.1%) patient suffered an acute myocardial infarction and received percutaneous coronary intervention with no redo-surgery. All patients are alive and angina-free. CONCLUSIONS Left thoracotomy for conventional revascularization is a safe procedure for appropriately selected patients, with few early complications and good early and mid-term results. More cases are ongoing and long-term results are in observation.
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Affiliation(s)
- Dongyan Yang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Kai Zhang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Junshan Li
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Dong Wei
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Jing Ma
- Institute of Cardiovascular Diseases, Tianjin Chest Hospital, Tianjin, China
| | - Yulong Wang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Yin Yang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Jinghui Li
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Yunpeng Bai
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Yuhui Zhang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Jing Gao
- Institute of Cardiovascular Diseases, Tianjin Chest Hospital, Tianjin, China
| | - Lianqun Wang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
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Stanislawski R, Aboul-Hassan SS, Marczak J, Stankowski T, Peksa M, Nawotka M, Cichon R. Early and long-term clinical outcomes after minimally invasive direct coronary artery bypass grafting versus off-pump coronary surgery via sternotomy in isolated proximal left anterior descending artery disease: A propensity score matching analysis. J Card Surg 2020; 35:3412-3419. [PMID: 32985720 DOI: 10.1111/jocs.15056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was designed to compare short-term and long-term clinical outcomes of minimally invasive direct coronary artery bypass (MIDCAB) and off-pump coronary artery bypass grafting (OPCAB) via median sternotomy in patients with single-vessel left anterior descending (LAD) artery disease. METHODS In this retrospective study, 194-patients met the inclusion criteria and were divided into the MIDCAB group (n = 111) and OPCAB via median sternotomy group (n = 83). Short-term outcomes included: in-hospital mortality, perioperative myocardial infarction (MI), perioperative cerebrovascular adverse events (CAEs), chest drainage, reoperation for bleeding, duration of surgery, ventilation time, deep wound infection, packed red blood cell (pRBC) transfusion and duration of hospital stay. The long-term outcomes included: all-cause mortality, the incidence of MI and stroke, target vessel revascularization (TVR) and composite of mortality/MI/stroke. Propensity score matching (PSM) was used to match patients between the groups. RESULTS Before as well as after the PSM, no significant differences were observed between both groups in terms of in-hospital mortality, incidence of perioperative MI, incidence of CAEs, reoperation for bleeding, pRBC transfusions, deep wound infection and ventilation time. However, MIDCAB group had lower chest tube drainage and shorter hospital stay. On the other hand, OPCAB group had shorter time of surgery before as well as after PS matching. At 7-years, before and after PSM, freedom from all-cause mortality, MI, stroke, TVR as well as composite of mortality/MI/stroke were comparable between both groups. CONCLUSIONS Short-term as well as long-term outcomes of MIDCAB in terms of mortality, MI, stroke, and target vessel revascularization are satisfactory and as safe and effective as OPCAB via sternotomy.
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Affiliation(s)
| | | | - Jakub Marczak
- Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospital, Nottingham, UK
| | - Tomasz Stankowski
- Department of Cardiac Surgery, Sana-Heart Center Cottbus, Cottbus, Germany
| | - Maciej Peksa
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland
| | - Marcin Nawotka
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland
| | - Romuald Cichon
- Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland.,Department of Cardiac Surgery, Warsaw Medical University, Warsaw, Poland
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Revascularización coronaria quirúrgica mínimamente invasiva (MIDCAB). CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ling Y, Bao L, Yang W, Chen Y, Gao Q. Minimally invasive direct coronary artery bypass grafting with an improved rib spreader and a new-shaped cardiac stabilizer: results of 200 consecutive cases in a single institution. BMC Cardiovasc Disord 2016; 16:42. [PMID: 26883122 PMCID: PMC4756454 DOI: 10.1186/s12872-016-0216-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 02/09/2016] [Indexed: 11/23/2022] Open
Abstract
Background Performing minimally invasive direct coronary artery bypass (MIDCAB) grafting via small chest incisions on a beating heart is challenging. We report our experiences of MIDCAB with the utilization of both an improved rib spreader to harvest the left internal mammary artery (LIMA) and a new-shaped cardiac stabilizer to facilitate LIMA-left anterior descending (LAD) coronary anastomosis. Methods Between May 2012 and June 2104, a total of 200 patients who were consecutively operated on in this period were enrolled in this study. Data reported included demographic information, preoperative clinical and cardiac status, LIMA harvest time, postoperative in-hospital outcomes, and 30-day mortality. Results The average LIMA harvest time was 43 min. The mean age was 62.59 ± 10.19 years, and 45 of the 200 were females. The 30-day mortality was 0.5 % (one patient) due to perioperative myocardial infarction. Duration of mechanical ventilation and length of stay in intensive care unit was 9.27 ± 7.65 and 24.27 ± 17.85 h, respectively. The unit of packed RBC transfusion was 0.79 ± 1.58. Postoperative atrial fibrillation was observed in 14 (7 %) patients. There was no postoperative stroke, renal failure, or incision complication. Conclusion Performing MIDCAB with the improved retractor and stabilizer utilized in this study showed favorable outcomes in terms of harvesting the LIMA, postoperative morbidities, and 30-day mortality.
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Affiliation(s)
- Yunpeng Ling
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China.
| | - Liming Bao
- Department of Cardiac Surgery, Aero Space Center Hospital, Beijing, China.
| | - Wei Yang
- Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China.
| | - Yu Chen
- Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China.
| | - Qing Gao
- Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China.
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Birla R, Patel P, Aresu G, Asimakopoulos G. Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy. Ann R Coll Surg Engl 2013; 95:481-5. [PMID: 24112493 PMCID: PMC5827271 DOI: 10.1308/003588413x13629960047119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy. METHODS Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners. RESULTS Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05). CONCLUSIONS MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.
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Surgical pitfalls of minimally invasive direct coronary artery bypass procedure from the viewpoint of a surgeon in the learning curve. Wideochir Inne Tech Maloinwazyjne 2013; 8:74-9. [PMID: 23630558 PMCID: PMC3627150 DOI: 10.5114/wiitm.2011.30945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/09/2012] [Accepted: 07/20/2012] [Indexed: 12/02/2022] Open
Abstract
Introduction Minimally invasive direct coronary artery bypass grafting (MIDCAB) offers arterial revascularization of the left anterior descending (LAD) coronary artery especially in lesions unsuitable for percutaneous coronary interventions. By avoidance of sternotomy and cardiopulmonary bypass its invasiveness is less than that of conventional bypass surgery. Aim We in this study discuss our surgical experience in the MIDCAB procedure. Material and methods Thirteen patients were operated on with the MIDCAB procedure. The inclusion criteria for MIDCAB were pure LAD disease totally occluded or severely stenotic. Patient demographics and preoperative and postoperative data were analyzed. Results Mean age of the patients was 60.0 ±8.6 years. Patients’ preoperative and postoperative levels of cardiac CK-MB (creatine kinase MB) were not significantly different (p = 0.993). However, cardiac troponin I (p < 0.001), hemoglobin (p < 0.001) and hematocrit (p < 0.001) were significantly different. No perioperative myocardial infarctions or cerebrovascular accidents were seen. The patients were discharged at a mean day of 4.77 with oral antiaggregant therapy. No mortality was seen in the study population. Conclusions Minimally invasive direct coronary artery bypass is associated with few perioperative complications. Minimally invasive direct coronary artery bypass in our experience is a very good option for single vessel LAD disease.
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Jegaden O, Wautot F, Sassard T, Szymanik I, Shafy A, Lapeze J, Farhat F. Is there an optimal minimally invasive technique for left anterior descending coronary artery bypass? J Cardiothorac Surg 2011; 6:37. [PMID: 21439055 PMCID: PMC3076235 DOI: 10.1186/1749-8090-6-37] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 03/25/2011] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this retrospective study was to evaluate the clinical outcome of three different minimally invasive surgical techniques for left anterior descending (LAD) coronary artery bypass grafting (CABG): Port-Access surgery (PA-CABG), minimally invasive direct CABG (MIDCAB) and off-pump totally endoscopic CABG (TECAB). Methods Over a decade, 160 eligible patients for elective LAD bypass were referred to one of the three techniques: 48 PA-CABG, 53 MIDCAB and 59 TECAB. In MIDCAB group, Euroscore was higher and target vessel quality was worse. In TECAB group, early patency was systematically evaluated using coronary CT scan. During follow-up (mean 2.7 ± 0.1 years, cumulated 438 years) symptom-based angiography was performed. Results There was no conversion from off-pump to on-pump procedure or to sternotomy approach. In TECAB group, there was one hospital cardiac death (1.7%), reoperation for bleeding was higher (8.5% vs 3.7% in MIDCAB and 2% in PA-CABG) and 3-month LAD reintervention was significantly higher (10% vs 1.8% in MIDCAB and 0% in PA-CABG). There was no difference between MIDCAB and PA-CABG groups. During follow-up, symptom-based angiography (n = 12) demonstrated a good patency of LAD bypass in all groups and 4 patients underwent a no LAD reintervention. At 3 years, there was no difference in survival; 3-year angina-free survival and reintervention-free survival were significantly lower in TECAB group (TECAB, 85 ± 12%, 88 ± 8%; MIDCAB, 100%, 98 ± 5%; PA-CABG, 94 ± 8%, 100%; respectively). Conclusions Our study confirmed that minimally invasive LAD grafting was safe and effective. TECAB is associated with a higher rate of early bypass failure and reintervention. MIDCAB is still the most reliable surgical technique for isolated LAD grafting and the least cost effective.
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Affiliation(s)
- Olivier Jegaden
- Department of cardiac surgery and transplantation, Hospital Louis Pradel, University Claude Bernard Lyon1, INSERM 886, 59 Boulevard Pinel, 69677 Bron, France.
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