“…Multi-vessel MICS CABG has been a routine approach at our center since 2005 (7). Its experience and outcomes have been reported with excellent results by multiple centers after our initial series (7)(8)(9)(10)(11). The aim of this paper is to share the techniques and pitfalls learned during these years of experience.…”
Section: Introductionmentioning
confidence: 90%
“…The outcomes of Multi-vessel MICS CABG have been extensively published by our group (7)(8)(9). In our last publication (8), 510 consecutive patients who underwent MICS CABG from September 2005 to December 2020 were analyzed.…”
Coronary artery bypass grafting (CABG) has been changing since its initial reports. There has been a shift from standard CABG, which uses sternotomy and a single left internal mammary to the left anterior descending artery (LAD) grafting, plus vein grafts to other targets, and performed on bypass with aortic cross-clamping. We now have CABG using multiarterial grafts, avoiding manipulation of the aorta, and through a minimally invasive approach. Beating heart Multi-vessel Minimally Invasive Coronary Artery Bypass (Multi-vessel MICS CABG) has emerged as an attractive alternative in coronary revascularization.The minimally invasive approach mitigates some of the risks and long recovery associated with the more invasive standard full sternotomy approach. It decreases the rates of wound infection, transfusion, postoperative pain, time of recovery and sternal dehiscence, while maintaining the same outcomes as the standard approach with full sternotomy. There are multiple centers around the world that have reported safe and good outcomes with Multi-vessel MICS CABG, including the initial report from our center joint with Staten Island, NY. The aim of this paper is to describe the technique and pitfalls of Multi-vessel MICS CABG as used at our center and go over patient selection and outcomes. A video and several pictures are shown to facilitate the understanding and learning of this technique.
“…Multi-vessel MICS CABG has been a routine approach at our center since 2005 (7). Its experience and outcomes have been reported with excellent results by multiple centers after our initial series (7)(8)(9)(10)(11). The aim of this paper is to share the techniques and pitfalls learned during these years of experience.…”
Section: Introductionmentioning
confidence: 90%
“…The outcomes of Multi-vessel MICS CABG have been extensively published by our group (7)(8)(9). In our last publication (8), 510 consecutive patients who underwent MICS CABG from September 2005 to December 2020 were analyzed.…”
Coronary artery bypass grafting (CABG) has been changing since its initial reports. There has been a shift from standard CABG, which uses sternotomy and a single left internal mammary to the left anterior descending artery (LAD) grafting, plus vein grafts to other targets, and performed on bypass with aortic cross-clamping. We now have CABG using multiarterial grafts, avoiding manipulation of the aorta, and through a minimally invasive approach. Beating heart Multi-vessel Minimally Invasive Coronary Artery Bypass (Multi-vessel MICS CABG) has emerged as an attractive alternative in coronary revascularization.The minimally invasive approach mitigates some of the risks and long recovery associated with the more invasive standard full sternotomy approach. It decreases the rates of wound infection, transfusion, postoperative pain, time of recovery and sternal dehiscence, while maintaining the same outcomes as the standard approach with full sternotomy. There are multiple centers around the world that have reported safe and good outcomes with Multi-vessel MICS CABG, including the initial report from our center joint with Staten Island, NY. The aim of this paper is to describe the technique and pitfalls of Multi-vessel MICS CABG as used at our center and go over patient selection and outcomes. A video and several pictures are shown to facilitate the understanding and learning of this technique.
“…The outcomes of this operation have also been validated by several groups, and data pertaining to its safety, feasibility, adoptability, angiographic patency of grafts and, as of recently, long-term durability, are now available. 3 , 4 , 5 , 6 A randomized clinical trial comparing multivessel surgical revascularization by MICS CABG versus regular sternotomy has, as of this writing, completed nearly one half of its recruitment. 7 …”
Section: A Need For Less-invasive Coronary Bypass Surgerymentioning
confidence: 99%
“…21 Perioperative mortality and stroke each occurred in 1 patient, for an incidence of 0.2%. 6 Figure 5 MICS CABG incisions 1 month postoperatively. Patient who underwent (A) multiarterial multivessel MICS CABG with (B) an endoscopically harvested left radial artery.…”
Section: What Is Known About Mics Cabg and What Remains To Be Demonstratedmentioning
confidence: 99%
“…In this report, the results of MICS CABG showed high durability at 10 years, with more than 90% of patients alive and 80% of patients both alive and free from any major adverse cardiovascular or cerebrovascular event, including repeat revascularisation. 6 …”
Section: What Is Known About Mics Cabg and What Remains To Be Demonstratedmentioning
A NEED FOR LESS-INVASIVE CORONARY BYPASS SURGERYIn the 1990s and early 2000s, attempts at performing lessinvasive coronary artery bypass grafting (CABG) were largely restricted to the minimally invasive direct coronary artery bypass operation, itself a variation of the first CABG operation performed-in 1964 and through a thoracotomy-by Kolesov and Potashov. 1 With the exception of multiple anterior target coronary vessels and other rare favorable combinations, multivessel bypass grafting through a nonsternotomy incision was not considered feasible until a large consecutive patient series was published in 2009. 2 These minimally invasive (MICS) CABG data became a catalyst for the adoption, over the ensuing decade, of this operation at other expert centers in America, Asia, Europe, and Oceania. Nowadays, it is estimated that thousands of MICS CABGs are performed every year. Nevertheless, multivessel MICS CABG remains a technically challenging operation performed only at select centers. Complete ease of the surgeon and team at off-pump coronary artery bypass (OPCAB) represents 1 prerequisite, after which surgeons should initiate single-vessel MICS CABG to the left anterior descending artery, performed either conventionally or with robotic assistance. Numerous training programs and peer-to-peer options exist for surgeons and teams who wish to learn and develop MICS CABG. The outcomes of this operation have also been validated by several groups, and data pertaining to its safety, feasibility, adoptability, angiographic patency of grafts and, as of recently, long-term durability, are now available. 3-6 A randomized clinical trial comparing multivessel surgical revascularization by MICS CABG versus regular From the
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