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Weymann A, Amanov L, Beltsios E, Arjomandi Rad A, Szczechowicz M, Merzah AS, Ali-Hasan-Al-Saegh S, Schmack B, Ismail I, Popov AF, Ruhparwar A, Zubarevich A. Minimally Invasive Direct Coronary Artery Bypass Grafting: Sixteen Years of Single-Center Experience. J Clin Med 2024; 13:3338. [PMID: 38893048 PMCID: PMC11173276 DOI: 10.3390/jcm13113338] [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: 04/30/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Coronary artery disease is a major cause of death globally. Minimally invasive direct coronary artery bypass (MIDCAB), using a small left anterior thoracotomy, aims to provide a less invasive alternative to traditional procedures, potentially improving patient outcomes with reduced recovery times. Methods: This retrospective, non-randomized study analyzed 310 patients who underwent MIDCAB between July 1999 and April 2022. Data were collected on demographics, clinical characteristics, operative and postoperative outcomes, and follow-up mortality and morbidity. Statistical analysis was conducted using IBM SPSS, with survival curves generated via the Kaplan-Meier method. Results: The cohort had a mean age of 63.3 ± 10.9 years, with 30.6% females. The majority of surgeries were elective (76.1%), with an average operating time of 129.7 ± 35.3 min. The median rate of intraoperative blood transfusions was 0.0 (CI 0.0-2.0) Units. The mean in-hospital stay was 8.7 ± 5.5 days, and the median ICU stay was just one day. Early postoperative complications were minimal, with a 0.64% in-hospital mortality rate. The 6-month and 1-year mortalities were 0.97%, with a 10-year survival rate of 94.3%. There were two cases of perioperative myocardial infarction and no instances of stroke or new onset dialysis. Conclusions: The MIDCAB approach demonstrates significant benefits in terms of patient recovery and long-term outcomes, offering a viable and effective alternative for patients suitable for less invasive procedures. Our results suggest that MIDCAB is a safe option with favorable survival rates, justifying its consideration in high-volume centers focused on minimally invasive techniques.
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Affiliation(s)
- Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Lukman Amanov
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Eleftherios Beltsios
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | | | - Marcin Szczechowicz
- Department of Cardiac Surgery, University Hospital Halle, 06120 Halle (Saale), Germany
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Bastian Schmack
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Issam Ismail
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Aron-Frederik Popov
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany (A.S.M.)
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Jinghui L, Yin Y, Xiaokaitijiang M, Yipeng T, Lianqun W, Yunpeng B, Zhejun Z, Nan J, Qiang W, Qingliang C, Dong X, Dongyan Y, Zhigang G, Feng Z. Comparison of clinical effects of coronary artery bypass grafting between left anterior small thoracotomy approach and lower-end sternal splitting approach. J Int Med Res 2024; 52:3000605241247656. [PMID: 38818531 PMCID: PMC11143834 DOI: 10.1177/03000605241247656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 03/28/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVE To compare the clinical effects of coronary artery bypass grafting (CABG) between the left anterior small thoracotomy (LAST) and lower-end sternal splitting (LESS) approaches for coronary artery disease. METHODS In total, 110 patients who underwent LAST from October 2015 to December 2020 in Tianjin Chest Hospital were selected as the observation group. Patients who underwent the LESS approach during the same period were analyzed. The propensity score was calculated by a logistic regression model, and nearest-neighbor matching was used for 1:1 matching. RESULTS The length of hospital stay and ventilator support time were significantly shorter in the LAST than LESS group. The target vessels in the obtuse marginal branch and posterior left ventricular artery branch grafts were significantly more numerous in the LAST than LESS group, but those in the right coronary artery graft were significantly less numerous in the LAST group. CONCLUSIONS CABG using either the LAST or LESS approach is safe and effective, especially in low-risk patients. The LAST approach can achieve complete revascularization for multivessel lesions and has the advantages of less trauma and an aesthetic outcome. However, it requires a certain learning curve to master the surgical techniques and has specific surgical indications.
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Affiliation(s)
- Li Jinghui
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
- Clinical College of Thoracic Medicine, Tianjin Medical University, Tianjin, P.R. China
| | - Yang Yin
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
- Clinical College of Thoracic Medicine, Tianjin Medical University, Tianjin, P.R. China
| | | | - Tang Yipeng
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Wang Lianqun
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Bai Yunpeng
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Zhang Zhejun
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Jiang Nan
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Wang Qiang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Chen Qingliang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Xu Dong
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Yang Dongyan
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Guo Zhigang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
| | - Zhao Feng
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, P.R. China
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Claessens J, Goris P, Yilmaz A, Van Genechten S, Claes M, Packlé L, Pierson M, Vandenbrande J, Kaya A, Stessel B. Patient-Centred Outcomes after Totally Endoscopic Cardiac Surgery: One-Year Follow-Up. J Clin Med 2023; 12:4406. [PMID: 37445440 DOI: 10.3390/jcm12134406] [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: 05/05/2023] [Revised: 05/31/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Patient-centred outcomes have grown in popularity over recent years in surgical care research. These patient-centred outcomes can be measured through the health-related quality of life (HRQL) without professional interpretations. In May 2022, a study regarding patient-centred outcomes up to 90 days postoperatively was published. Fourteen days after surgery, the HRQL decreased and returned to baseline levels after 30 days. Next, the HRQL significantly improved 90 days postoperatively. However, this study only focuses on a short-term follow-up of the patients. Hence, this follow-up study aims to assess the HRQL one year after totally endoscopic cardiac surgery. At baseline, 14, 30, and 90 days, and one year after surgery, the HRQL was evaluated using a 36-item short form and 5-dimensional European QoL questionnaires (EQ-5D). Using the 36-item short form questionnaire, a physical and mental component score is calculated. Over the period of one year, this physical and mental component score and the EQ-5D index value significantly improve. According to the visual analogue scale of the EQ-5D, patients score their health significantly higher one year postoperatively. In conclusion, after endoscopic cardiac surgery, the HRQL is significantly improved 90 days postoperatively and remains high one year afterward.
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Affiliation(s)
- Jade Claessens
- Faculty of Medicine and Life Sciences, UHasselt-Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Pieter Goris
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Silke Van Genechten
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Marithé Claes
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Loren Packlé
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Maud Pierson
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Jeroen Vandenbrande
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Abdullah Kaya
- Faculty of Medicine and Life Sciences, UHasselt-Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Björn Stessel
- Faculty of Medicine and Life Sciences, UHasselt-Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
- Department of Anesthesiology, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
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Reuthebuch O, Stein A, Koechlin L, Gahl B, Berdajs D, Santer D, Eckstein F. Five-Year Survival of Patients Treated with Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) Compared with the General Swiss Population. Thorac Cardiovasc Surg 2023. [PMID: 37044119 DOI: 10.1055/s-0043-1768035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND To evaluate the midterm follow-up and 5-year survival outcome of the minimally invasive direct coronary artery bypass (MIDCAB) procedure compared with the survival of the general Swiss population. METHODS Retrospective study on preoperative data, intraoperative data, and postoperative outcome of patients who underwent MIDCAB surgery between June 2010 and February 2019. To assess validity of this surgical therapy, outcomes were compared with survival data of a gender- and age-matched cohort of the general Swiss population taken from the database of the Swiss Federal Statistical Office. RESULTS A total of 88 patients were included. Median (interquartile range [IQR[) age was 66 (56-75) years, and 27% (n = 24) were female. The median (IQR) length of the in-hospital stay was 7 (6-8) days. No postoperative stroke occurred. The 30-day mortality was 1.1% (n = 1). Reintervention for failed left internal mammary artery was needed in 1.1% (n = 1). The median (IQR) ejection fraction was 58% (47-60) preoperatively and remained stable during follow-up. The median (IQR) follow-up period was 3 (1.1-5.2) years. Five years postoperatively, 83% (confidence interval, 69-91) of the patients were alive, showing an overlap with the range of survival of the matched subcohort of the general Swiss population (range, 84-100%). CONCLUSION Though suffering from coronary heart disease, patients after MIDCAB show almost equal survival rates as an equivalent subcohort corresponding to the general Swiss population matched on age and gender. Thus, our data show this treatment to be safe and beneficial.
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Affiliation(s)
- Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Alina Stein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Denis Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
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Mastroiacovo G, Manganiello S, Pirola S, Tedesco C, Cavallotti L, Antona C, Alamanni F, Pompilio G. Very Long-term Outcome of Minimally Invasive Direct Coronary Artery Bypass. Ann Thorac Surg 2021; 111:845-852. [DOI: 10.1016/j.athoracsur.2020.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
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Alom S, Yang N, Bin Saeid J, Zeinah M, Harky A. Harvesting internal mammary artery: a narrative review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 61:790-801. [DOI: 10.23736/s0021-9509.20.11216-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Minimally invasive direct CABG versus off-pump CABG: Can less be more. Hellenic J Cardiol 2020; 61:125-126. [PMID: 32580018 DOI: 10.1016/j.hjc.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 11/21/2022] Open
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Fischlein T. Commentary: Minimally invasive direct coronary artery bypass: Reawakening of a sleeping beauty? J Thorac Cardiovasc Surg 2019; 158:139-140. [PMID: 30630608 DOI: 10.1016/j.jtcvs.2018.11.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.
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Affiliation(s)
- Junichi Sugita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.,Department of Advanced Cardiology, Graduate School of Medicine, The University of Tokyo
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