Minimally Invasive Coronary Artery Bypass Grafting

Abstract

Background-Minimally invasive coronary artery bypass grafting (MICS CABG) is a novel coronary operation that does not require infrastructure and is potentially available to all cardiac surgeons. It aims at decreasing the invasiveness of conventional CABG while preserving the applicability and durability of surgical revascularization. We examined the feasibility and safety of MICS CABG in the first large series of this operation to date. Methods and Results-All myocardial territories are accessed via a 4-to 6-cm left fifth intercostal thoracotomy. An apical positioner and epicardial stabilizer are introduced into the chest through the subxyphoid and left seventh intercostal spaces, respectively. The left internal thoracic artery is used to graft the left anterior descending artery, and radial artery or saphenous vein segments are used to graft the lateral and inferior myocardial territories. Proximal anastomoses are performed directly onto the aorta or from the left internal thoracic artery as a T-graft. In the first 450 consecutive MICS CABG procedures at our 2 centers, meanϮSD age was 62.3Ϯ10.7 years and 123 patients were female (27%). The average number of grafts was 2.1Ϯ0.7, with complete revascularization in 95% of patients. There were 34 patients in whom cardiopulmonary bypass was used (7.6%), 17 conversions to sternotomy (3.8%), and 10 reinterventions for bleeding (2.2%). Perioperative mortality occurred in 6 patients (1.3%). Conclusions-MICS CABG is feasible and has excellent procedural and short-term outcomes. This operation could potentially make multivessel minimally invasive coronary surgery safe, effective, and more widely available.

Off‐Pump Coronary Artery Bypass Grafting: 30 Years of Debate

“…Three main options for the performance of CABG without sternotomy are now available (Table 3): (1) minimally invasive CABG, in which all areas of the heart are bypassed via a small left anterolateral thoracotomy, usually without the use of the heart–lung machine123; (2) robotic total endoscopic coronary bypass grafting, in which robotic techniques are used not only for internal mammary artery harvest but also for the performance of all graft anastomoses124; and (3) HCR, which combines the performance of a single LIMA‐LAD graft via a small anterolateral thoracotomy, with PCI to the other myocardial territories of the heart that require revascularization 125…”

Cardiac surgery using a single thoracic port—current status and future directions

“…McGinn and Lapierre (6). Using the aforementioned devices, safe full coronary revascularization has been possible in selected patients, with very good long term results (6-9).…”

Hybrid minimally invasive myocardial revascularization in multivessel coronary disease . Current status of the issue

“…По определению Holzhey под гибридной технологи-ей восстановления кровотока при множествен-ном поражении коронарных артерий понимается шунтирование бассейна ПНА с использованием маммарокоронарного шунта in situ и сочетанное ЧКВ на остальных бассейнах в сроки до 3 суток [37]. Концепция гибридной реваскуляризации основана на успешных результатах шунтирова-ния ПНА левой внутренней грудной артерией, используя минимально инвазивную методику без стернотомии и манипуляций на аорте (MID CAB), что позволяет снизить риск неврологиче-ских, инфекционных и геморрагических ослож-нений, а также на удовлетворительных результа-тах функционирования стентов DES по сравне-нию с аутовенозными шунтами [38][39][40]. Данная технология была успешно внедрена в НИИ ком-плексных проблем сердечно-сосудистых заболе-ваний и получила дальнейшее развитие.…”