Coronary Artery Bypass Grafting using Bilateral Internal Thoracic Arteries through a Left-Sided Minithoracotomy: A Single-Center Starting Experience

Diab, Mahmoud; Färber, Gloria; Sponholz, Christoph; Tasar, Raphael; Tkebuchava, S.; Franz, Marcus; Doenst, Torsten

doi:10.1055/s-0038-1670632

Cited by 12 publications

(9 citation statements)

References 31 publications

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“…Minimally invasive CABG is often a compromise between surgical trauma and complete revascularization, and the number of distal anastomoses performed in surgical revascularization of patients with multi-vessel disease is considered as an indirect parameter for the completeness of revascularization [ 13 ]. The number of distal anastomoses in this initial pilot series compares well to the average number of 3.2 reported for conventional CABG in the recent German Heart Surgery Report 2018 [ 14 ], but it clearly exceeds that reported in MICS CABG [ 3 , 4 , 9 – 11 ].…”

Section: Discussionsupporting

confidence: 64%

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Novel concept of routine total arterial coronary bypass grafting through a left anterior approach avoiding sternotomy

Dörge¹,

Sellin²,

Belmenai³

et al. 2022

Heart Vessels

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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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Section: Discussionsupporting

confidence: 64%

“…The small thoracic incision is located more anteriorly compared to a more lateral approach used in other MICS CABG [3,4,[9][10][11]. This technical detail is important because distance from the incision to both aorta as well as coronary target sites becomes shorter.…”

Section: Discussionmentioning

confidence: 99%

Novel concept of routine total arterial coronary bypass grafting through a left anterior approach avoiding sternotomy

Dörge¹,

Sellin²,

Belmenai³

et al. 2022

Heart Vessels

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“…Considering the learning curve, our aortic cross clamp and CPB times were comparable with reported times of others. 4,5 Based on our experience with minimally invasive isolated aortic, mitral, and tricuspid valve surgery, [17][18][19] we started our RMT approach to perform multiple valve procedures in 2014. Since October 2010, we have performed over 1,500 minimally invasive valve operations with an average aortic cross-clamp time below 70 minutes and a total procedural time below 180 minutes (unpublished data).…”

Section: Discussionmentioning

confidence: 99%

Right Mini-Thoracotomy for Aortic Plus Mitral with or without Tricuspid Valve Surgery

Faerber

Tkebuchava

Scherag

et al. 2020

Thorac Cardiovasc Surg

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Objectives Minimally invasive surgery is increasingly performed for isolated aortic or mitral valve procedures. However, combined minimally invasive aortic and mitral valve surgery is rare. We report our initial experience performing multiple valve procedures through a right-sided mini-thoracotomy (RMT) compared with sternotomy. Methods A total of 264 patients underwent aortic and mitral with or without tricuspid valve surgery through RMT (n = 25) or sternotomy (n = 239). Propensity score matching was used for outcome comparisons. Results Of the 264 patients, 25 (age: 72 ± 10 years; 72% male) underwent double (n = 19) and triple valve surgery (n = 6) through RMT and 239 (age: 71 ± 11 years; 54% male) underwent double (n = 176) and triple valve surgery (n = 63) through sternotomy. Sternotomy patients had more co-morbidities and preoperative risk factors (EuroSCORE II 10.25 ± 10.89 vs. RMT 3.58. ± 4.98; p < 0.001). RMT procedures were uneventful without intraoperative complications or conversions to sternotomy. After propensity score matching, surgical procedures were comparable between groups with a higher valve repair rate in RMT. Despite longer cardiopulmonary bypass times in RMT, there was no evidence for differences in 30-day mortality (RMT: n = 2 vs. sternotomy: n = 2) and there were no significant differences in other outcomes. During 5-year follow-up, reoperation was required in sternotomy patients only (n = 2). Follow-up echocardiography showed durable results after valve surgery. RMT patients showed higher survival probability compared with sternotomy, although this difference was not significant (hazard ratio = 0.33; 95% confidence interval: 0.06–1.65; p = 0.18). Conclusion Combined aortic plus mitral with or without tricuspid valve surgery can safely be performed through a RMT with a trend toward better mid-term outcomes.

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“…2 (A) Survival (upper panel) and number of patients at risk (middle panel) after having undergone bypass surgery, subdivided according to surgeon expertise which was determined by years of practice after board certification (bottom panel) 25 (reproduced with permission). (B) Intraoperative photography of surgical access for a MIDCAB procedure with use of both internal thoracic arteries 30 (reproduced with permission). (C) photo of a Y-anastomosis between the left and the right internal thoracic artery and the postoperative angiogram 29 (reproduced with permission).…”

Section: Minimally Invasive Cabgmentioning

confidence: 99%

Cardiac Surgery 2020 Reviewed

Doenst

Caldonazo

Schneider

et al. 2021

Thorac Cardiovasc Surg

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In 2020, nearly 30,000 published references appeared in the PubMed for the search term “cardiac surgery.” While SARS-CoV-2 affected the number of surgical procedures, it did not affect outcomes reporting. Using the PRISMA approach, we selected relevant publications and prepared a results-oriented summary. We reviewed primarily the fields of coronary and conventional valve surgery and their overlap with interventional alternatives. The coronary field started with a discussion on trial data value and their interpretation. Registry comparisons of coronary artery bypass surgery (CABG) and percutaneous coronary intervention confirmed outcomes for severe coronary artery disease and advanced comorbidities with CABG. Multiple arterial grafting was best. In aortic valve surgery, meta-analyses of randomized trials report that transcatheter aortic valve implantation may provide a short-term advantage but long-term survival may be better with classic aortic valve replacement (AVR). Minimally invasive AVR and decellularized homografts emerged as hopeful techniques. In mitral and tricuspid valve surgery, excellent perioperative and long-term outcomes were presented for structural mitral regurgitation. For both, coronary and valve surgery, outcomes are strongly dependent on surgeon expertise. Kidney disease increases perioperative risk, but does not limit the surgical treatment effect. Finally, a cursory look is thrown on aortic, transplant, and assist-device surgery with a glimpse into the current stand of xenotransplantation. As in recent years, this article summarizes publications perceived as important by us. It does not expect to be complete and cannot be free of individual interpretation. We aimed to provide up-to-date information for decision-making and patient information.

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Coronary Artery Bypass Grafting using Bilateral Internal Thoracic Arteries through a Left-Sided Minithoracotomy: A Single-Center Starting Experience

Abstract: Myocardial revascularization using BITA can be safely achieved off-pump through a left-sided minithoracotomy with good postoperative and short-term outcomes.

Cited by 12 publications

References 31 publications

Novel concept of routine total arterial coronary bypass grafting through a left anterior approach avoiding sternotomy

Novel concept of routine total arterial coronary bypass grafting through a left anterior approach avoiding sternotomy

Right Mini-Thoracotomy for Aortic Plus Mitral with or without Tricuspid Valve Surgery

Cardiac Surgery 2020 Reviewed

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