Left thoracotomy approach for off-pump coronary artery bypass grafting surgery: 15 years of experience in 2500 consecutive patients

Guida, Gustavo; Guida, Gabriel; Bruno, Vito Domenico; Zakkar, Mustafa; Gárate, Estefania De; Pecchinenda, Miriam; Homes, Alfredo; Borzellino, Calogerino; Mendoza, Pablo; Pecora, Giuseppina; Bonillo, Ivan; Benedetto, Umberto; Calafiore, Antonio M.; Angelini, Gianni; Guida, M.

doi:10.1093/ejcts/ezz180

Cited by 11 publications

(12 citation statements)

References 18 publications

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Section: Discussionmentioning

confidence: 99%

“…In the era of minimally invasive surgery, patients prefer durable outcomes with less invasive approaches, which help them to recover their normal activity. Minimally invasive coronary surgery–CABG (MICS CABG) via left anterior thoracotomy is reportedly a less invasive and sternum‐sparing approach for multivessel or left main artery disease 6‐9 . Unlike CABG via a sternotomy, which has been studied for many years with convincing data showing its effectiveness and reproducibility, fewer objective data are available for MICS CABG, especially angiographic data regarding the graft patency and CR rates 10‐12 …”

Section: Introductionmentioning

confidence: 99%

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Graft patency and completeness of revascularization in minimally invasive multivessel coronary artery bypass surgery

Zhang

Gong

et al. 2021

J Card Surg

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Objectives Graft patency and completeness of revascularization were analyzed in patients who underwent off‐pump minimally invasive coronary artery bypass grafting via a left small thoracotomy. Methods We retrospectively reviewed the invasive angiography findings and clinical data of 186 consecutive patients who underwent off‐pump minimally invasive coronary artery bypass grafting via a left small thoracotomy. The left internal thoracic artery and saphenous vein were used to bypass two or more of three coronary artery systems: the left anterior descending artery, left circumflex artery, or right coronary artery. Before hospital discharge, invasive angiography was performed to assess graft patency. Clinical variables during hospitalization and follow‐up were collected and analyzed. Results All 186 patients successfully underwent off‐pump minimally invasive coronary artery bypass grafting without conversion to sternotomy or assistance of cardiopulmonary bypass. The mean graft number was 2.81 per patient (range, 2–5), and the total number of grafts was 522. The in‐hospital mortality rate was 1.6% (3 of 186). A total of 181 of 186 (97.3%) patients underwent postoperative invasive angiography. Among the 510 grafts assessed by angiography, the total graft patency rate was 96.3% (491 of 510) (98.3% [171 of 174] for left internal thoracic artery grafts and 95.2% [318 of 334] for saphenous vein grafts). The rate of complete revascularization was 99.5% (185 of 186). Conclusions Minimally invasive coronary artery bypass grafting using left internal thoracic artery and saphenous vein grafts provides acceptable graft patency and completeness of revascularization for selected patients with multivessel disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Graft patency and completeness of revascularization in minimally invasive multivessel coronary artery bypass surgery

Zhang

Gong

et al. 2021

J Card Surg

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“…This concept was then developed by Guida et al 8 who introduced a similar thoracotomy technique, named anterolateral thoracotomy coronary artery bypass (ALT‐CAB). Recently, these authors reported the 15‐year experience, including more than 2500 patients with excellent perioperative and long‐term results 9 . Later on, McGinn and Ruel 3 pioneered MICS CABG.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive multivessel coronary bypass surgery: Angiographic patency data

Снегирев¹,

Пайвин

Denisyuk³

et al. 2020

J Card Surg

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Objective Minimally invasive multivessel coronary artery bypass grafting (MIM CABG) has demonstrated its safety, effectiveness and high rate of reproducibility. However, minithoracotomy CABG is still rarely performed. In this study, we retrospectively analyze the CT‐angiographic graft patency rates for the patients subjected to this operation. Methods A total of 245 patients were subjected to MIM CABG by a left minithoracotomy approach between 2014 and 2018. The left internal thoracic artery (LITA) harvesting, proximal, and distal anastomoses were performed under direct vision. The patients then underwent 128‐slice computed tomography coronary angiography (CTA). The angiographic results were obtained for 127 (51.8%) patients (the follow‐up period of 31.1 ± 7.8 months, from 15 to 45 months). Of the total patients, 204 (83.2%) were followed clinically during the time period from 12 to 56 months. Results Complete revascularization was performed for all the patients. The mean number of grafts was 2.6 ± 0.5. The perioperative mortality was 0.4% (1 patient). There were two conversions to sternotomy (0.8%), four reopenings for bleeding (1.6%), three myocardial infarctions (1.2%), and one stroke (0.4%). Twenty‐two patients (9.0%) received transfusions. The long‐term mortality was 4.4% (nine patients). Three patients (1.5%) suffered from a stroke during the follow‐up period. For five patients (2.4%), repeat revascularization was necessary. For the examined patients, the overall graft patency rate was 89.8%, the LITA graft patency rate was 98.4%, the radial artery patency was 100%, and the saphenous vein graft patency was 84.0%. Conclusions MIM CABG allows complete surgical revascularization with excellent clinical outcomes and promising angiographic graft patency rates.

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“…MICS CABG has been proven to be a reliable and reproducible alternative to conventional CABG 6 . Convincing data show that MICS CABG provides the benefits of a low transfusion rate, short length of hospital stay, and rapid recovery to normal activity 7,12 . Graft patency and CR are predictive of the short-and long-term outcomes of patients who undergo coronary revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…In the era of minimally invasive surgery, patients prefer durable outcomes and less invasiveness, which help them to recover their normal activity. Minimally invasive coronary surgery-CABG (MICS CABG) via left anterior thoracotomy is reportedly a less invasive and sternum-sparing approach for multivessel or left main artery disease [6][7][8][9] . Unlike CABG via sternotomy, which has been studied for many years with convincing data showing its effectiveness and reproducibility, fewer objective data are available for MICS CABG, especially angiographic data regarding the graft patency and CR rates [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Graft patency and completeness of revascularization in minimally invasive multivessel coronary artery bypass surgery

Zhang

Gong

et al. 2020

Preprint

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Objectives: Graft patency and completeness of revascularization were analyzed in patients who underwent off-pump minimally invasive coronary artery bypass grafting via left small thoracotomy. Methods: We retrospectively reviewed the invasive angiography findings and clinical data of 186 consecutive patients who underwent off-pump minimally invasive coronary artery bypass grafting via left small thoracotomy. The left internal thoracic artery and saphenous vein were used to bypass two or more of three coronary artery systems: the left anterior descending artery, left circumflex artery, or right coronary artery. Before hospital discharge, invasive angiography was performed to assess graft patency and completeness of revascularization. Clinical variables during hospitalization and follow-up were collected and analyzed. Results: All 186 patients successfully underwent off-pump minimally invasive coronary artery bypass grafting without conversion to sternotomy or assistance of cardiopulmonary bypass. LITA Left internal thoracic artery LCX Left circumflex artery LM Left main artery LVEDD Left ventricular end-diastolic dimension MACCE Major adverse cardiovascular and cerebral events MI Myocardium infarction MICS CABG Minimally invasive coronary surgery-coronary artery bypass grafting OPCAB Off pump coronary artery bypass PCI Percutaneous coronary intervention RA Radial artery RBC Red blood cell RCA Right coronary artery SV Saphenous vein

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Left thoracotomy approach for off-pump coronary artery bypass grafting surgery: 15 years of experience in 2500 consecutive patients

Cited by 11 publications

References 18 publications

Graft patency and completeness of revascularization in minimally invasive multivessel coronary artery bypass surgery

Graft patency and completeness of revascularization in minimally invasive multivessel coronary artery bypass surgery

Minimally invasive multivessel coronary bypass surgery: Angiographic patency data

Graft patency and completeness of revascularization in minimally invasive multivessel coronary artery bypass surgery

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