Objective Our aim was to develop the minimally invasive coronary artery bypass grafting (CABG) technique, which is equally effective and safe compared with conventional coronary grafting technique, is reproducible, and can be applied in the vast majority of patients with isolated coronary artery disease. Methods From July 2017 to November 2018 a total of 170 nonselected consecutive patients underwent minimally invasive on-pump multivessel CABG through the left anterior minithoracotomy in the fourth intercostal space using a Chitwood clamp and blood cardioplegia. We named this technique total coronary revascularization via left anterior thoracotomy. The mean number of grafts was 3.1 ± 0.7. Left internal mammary artery was used in 159 (93.5%) patients, right internal mammary artery in 4 (2.4%) patients, radial artery in 25 (14.7%) patients, and veins in 148 (87%) patients. Results We had no mortality, no postoperative myocardial infarcts, and no conversion to sternotomy. There were 2 postoperative strokes without residual neurological deficit and 2 revisions for postoperative bleeding. The total operation time was 258.8 ± 43.9 minutes, cardiopulmonary bypass time 135.8 ± 26.6 minutes, and aortic cross-clamp time 71.2 ± 19.4 minutes. The mean intensive care stay was 2.1 ± 0.56 days and mean total hospital stay 6.3 ± 1.3 days. Conclusions Complete coronary revascularization could be routinely performed using the above-mentioned technique. No patient selection, based on number of grafts, quality and location of coronary vessels, left ventricle function, age, gender, or body mass index, is required.
Total survival was significantly lower in patients with the 22q11 deletion. Surgical management based on preoperative pulmonary arterial anatomical features improves early surgical results.
The aim — to describe personal experience of miniinvasive multivessel coronary grafting through left anterior minithoracotomy with the application of artificial bloodcirculation and hyperkalemic blood cardioplegia; to assess the results of surgery in the first group patients.Materials and methods. The method was performed for 29 patients. All patients underwent complete myocardium revascularization with 2 — 5 grafts (3.37 ± 0.82 per patient). Left internal mammary artery was used in all patients, right internal mammary artery — in 4 patients, radial artery — in 5 patints, vein grafts — in 23 patients. Complete arterial revascularization was performed in 6 patients.Results and discussion. We had no fatal outcomes. Mean aortic crossclamp time was 75.8 ± 21 min (range 48 — 146 min). Mean cardiopulmonary bypass time was 145.5 ± 38.37 min (range 103 — 296 min). Total surgery duration was 180 — 495 min. (mean 287.4 ± 61.7). Postoperatively, total drainage in the first 12 hours was 456.55 ± 214.39 ml, the post surgery grafts were left for 48 hours. Ventilation time was 7.6 ± 15.6 hours, ICU stay was 2.58 ± 1.21 days.Conclusions. Miniinvasive coronary bypass grafitng is effective and safe surgical method for miocardium revascularization. Complete revascularization could be performed regardless the number of grafts, left ventricle ejection fraction, quality and size of coronary vessels, age of patient.
Вступ. Представлено досвід мініінвазивного багатосудинного коронарного шунтування в умовах передньої торакотомії в хірургії ішемічної хвороби серця. Ми рутинно використовуємо розроблену нами методику незалежно від кількості шунтів, якості та локації коронарних артерій, скоротливої здатності лівого шлуночка, віку, ваги та статі пацієнта. Мета роботи. Описано розроблену нами методику мініінвазивного багатосудинного коронарного шунтування в умовах передньо мініторакотомії з використанням штучного кровообігу та кров'яної кардіоплегії. Матеріали і методи. Метод використано в 220 пацієнтів. Всім пацієнтам виконали повну реваскуляризацію міокарда. Кількість шунтів-від 2 до 5, в середньому-3,37± 0,68 на пацієнта. Ліва внутрішня мамарна артерія була використана у 206 пацієнтів, права внутрішня мамарна артерія-у 4 пацієнтів, променева артерія-у 37 пацієнтів, венозні кондуїти використовували-у 193 пацієнтів, повна артеріальна реваскуляризація виконана 29 пацієнтам.
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