Coronary artery bypass grafting and mitral valve replacement via a left anterior minithoracotomy

Babliak, Dmytro; Babliak, Oleksandr; Demianenko, Volodymyr; Marchenkoa, Anton

doi:10.1510/mmcts.2022.083

Cited by 3 publications

(2 citation statements)

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“…Recently, we discovered that MVR can be effectively exposed through the left anterior minithoracotomy (LAmT) [ 3 , 4 ], which we routinely use as a first-choice approach for multivessel CABG patients [ 5–7 ]. The possibility to access the AoV through the LAmT made it possible to perform combined coronary with AoV surgical procedures in selective patients through the single minithoracotomy.…”

Section: Introductionmentioning

confidence: 99%

New approach for combined aortic valve and coronary procedures through the left anterior minithoracotomy

Babliak,

Demianenko,

Babliak

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVE We have developed a novel technique for accessing the aortic valve (AoV) through the left anterior minithoracotomy. This approach has been used in patients requiring both AoV surgery and coronary artery bypass grafting (CABG). METHODS From April 2023 to July 2023 we performed 6 concomitant AoV procedures and CABG through the left anterior minithoracotomy. Mean age was 71.5 (SD: 5.8; 64; 82) years, mean left ventricular ejection fraction was 53% (SD: 12.1; 30; 60). Surgical technique includes left anterior minithoracotomy in the fourth intercostal space (ICS), peripheral cardiopulmonary bypass (CPB), aortic cross-clamping using transthoracic clamp, cold blood cardioplegia, conventional oblique aortotomy and special surgical exposure maneuvers, aimed to position the ascending aorta and aortic valve close to the surgical incision. RESULTS AoV was effectively visualized and the procedure was performed as planned in all 6 patients. No conversion to sternotomy was required. AVR with biological prosthesis was performed in 6 (100%) patients. Conventional surgical instruments were used in all cases. The long-shafted instruments were not required. Knot-pusher was used in 4 (67%)cases. Concomitant complete revascularization was achieved in all cases. Mean number of distal anastomosis was 2.0 (SD : 0.6; 1; 3). Total operation time was—371 (SD: 43; 300; 420) min, CPB time was—253 (SD: 36; 193; 284) min, cross-clamp time was - 162 (SD: 29; 128; 214) min. ICU stay was—1.5 (SD: 0.55; 1; 2) days, total hospital stay was—7.3 (SD: 1; 6; 9) days. There were no revisions for bleeding, no strokes or other major complications, no hospital or 30-days mortality. CONCLUSIONS The simultaneous performance of AVR and multivessel CABG through a single left anterior thoracotomy is technically feasible and can be carried out by experienced surgeons. However, a larger number of cases are required to fully comprehend the potential limitations of this procedure.

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Section: Introductionmentioning

confidence: 99%

New approach for combined aortic valve and coronary procedures through the left anterior minithoracotomy

Babliak,

Demianenko,

Babliak

et al. 2024

Interdisciplinary CardioVascular and Thoracic Surgery

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“… 1 However, procedures that combined MV repair or replacement with coronary artery bypass grafting (CABG) are still typically performed through a median sternotomy. Recently, we have found that the MV can be effectively accessed through the left anterior minithoracotomy (LAmT), 2 which we routinely use as the primary approach for patients undergoing multivessel CABG. 3 , 4 This discovery has enabled us to perform combined coronary and valve surgical procedures in selective patients through a single minithoracotomy.…”

mentioning

confidence: 99%

New approach to the mitral valve through the left anterior minithoracotomy for combined valve and coronary surgical procedures

Babliak,

Lazoryshynets,

Demianenko

et al. 2024

JTCVS Techniques

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Left anterior minithoracotomy as a first-choice approach for isolated coronary artery bypass grafting and selective combined procedures

Babliak¹,

Demianenko²,

Marchenko³

et al. 2023

European Journal of Cardio-Thoracic Surgery

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Objective To describe the technique 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 the 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 “Total Coronary Revascularization via left Anterior Thoracotomy” technique. Main perioperative outcomes were analysed. Results 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 operation time - 269 (SD: 51.8) and 324 (SD: 52.1) min, intensive care stay – 2(2-2) and 2(2-2) days, total hospital stay – 6(5-7) and 6(5-7) days, total 30-days mortality was 0.54 and 0% respectively. Conclusion Left anterior minithoracotomy can be effectively used as a first-choice approach to perform isolated multivessel coronary grafting and combined with mitral valve and/or left ventricular repair. Experience with isolated coronary grafting through the anterior minithoracotomy is required to achieve the satisfactory results in combined procedures.

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Coronary artery bypass grafting and mitral valve replacement via a left anterior minithoracotomy

Cited by 3 publications

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New approach for combined aortic valve and coronary procedures through the left anterior minithoracotomy

New approach for combined aortic valve and coronary procedures through the left anterior minithoracotomy

New approach to the mitral valve through the left anterior minithoracotomy for combined valve and coronary surgical procedures

Left anterior minithoracotomy as a first-choice approach for isolated coronary artery bypass grafting and selective combined procedures

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