Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future?

Nambiar, Pradeep; Kumar, Sanjay; Mittal, Chander Mohan; Saksena, Kailash

doi:10.1016/j.jtcvs.2017.07.088

Cited by 35 publications

(37 citation statements)

References 19 publications

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“…The patient was transferred out of the ICU on post-operative day 1 (after removal of chest drains, venous and arterial lines, and urinary catheter) and discharged to home on postoperative day 5. This is similar to described clinical outcomes in this operative population (1). The patient was seen in clinic for scheduled follow up on postoperative day 12 and was noted to be healing well with no residual pleural effusion on chest X-ray.…”

Section: Clinical Outcomesupporting

confidence: 82%

“…The morbidity of median sternotomy has led to increasing utilization of minimally invasive techniques in coronary artery bypass surgery (MICS). MICS may also complement the use of multiple arterial grafts for stenotic coronary artery disease (1). Additionally, this technique would appear to circumvent some of the described morbidities of bilateral internal mammary artery harvesting (2,3).…”

Section: Introductionmentioning

confidence: 99%

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Multiple arterial, minimally invasive coronary surgery (MA-MICS)

Hobson¹,

Lobdell²,

McGinn³

2018

Ann. Cardiothorac. Surg.

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Section: Clinical Outcomesupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Multiple arterial, minimally invasive coronary surgery (MA-MICS)

Hobson¹,

Lobdell²,

McGinn³

2018

Ann. Cardiothorac. Surg.

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“…With the recent advancement in the harvesting of bilateral mammary arteries from the left thoracotomy, TCRAT provides the potential for further advancing the range of patients who would benefit by combining minimally invasive procedure and complete arterial revascularization. 10,11…”

Section: Discussionmentioning

confidence: 99%

Complete Coronary Revascularization via Left Anterior Thoracotomy

Babliak¹,

Demianenko²,

Melnyk³

et al. 2019

Innovations�(Phila)

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Objective Our aim was to develop the minimally invasive coronary artery bypass grafting (CABG) technique, which is equally effective and safe compared with conventional coronary grafting technique, is reproducible, and can be applied in the vast majority of patients with isolated coronary artery disease. Methods From July 2017 to November 2018 a total of 170 nonselected consecutive patients underwent minimally invasive on-pump multivessel CABG through the left anterior minithoracotomy in the fourth intercostal space using a Chitwood clamp and blood cardioplegia. We named this technique total coronary revascularization via left anterior thoracotomy. The mean number of grafts was 3.1 ± 0.7. Left internal mammary artery was used in 159 (93.5%) patients, right internal mammary artery in 4 (2.4%) patients, radial artery in 25 (14.7%) patients, and veins in 148 (87%) patients. Results We had no mortality, no postoperative myocardial infarcts, and no conversion to sternotomy. There were 2 postoperative strokes without residual neurological deficit and 2 revisions for postoperative bleeding. The total operation time was 258.8 ± 43.9 minutes, cardiopulmonary bypass time 135.8 ± 26.6 minutes, and aortic cross-clamp time 71.2 ± 19.4 minutes. The mean intensive care stay was 2.1 ± 0.56 days and mean total hospital stay 6.3 ± 1.3 days. Conclusions Complete coronary revascularization could be routinely performed using the above-mentioned technique. No patient selection, based on number of grafts, quality and location of coronary vessels, left ventricle function, age, gender, or body mass index, is required.

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“…Complete total arterial revascularization via the MICS technique with BITAs was achieved in majority of the patients without conversion, and this compares favorably with earlier studies by McGinn et al 1 and Lapierre et al 2 However, in these studies only a single internal thoracic artery was used and the benefits of BITAs were not availed. 3,4 Further, complete arterial revascularization with BITAs in patients with poor LV function and raised pulmonary artery pressures, was achieved better than with formal CABG, despite the fact that majority of the patients were diabetic and a third of them were insulin dependent. The usage of ONCABG or peripheral pump assistance helped in keeping the mortality low in patients with poor LV function, as it prevented emergency conversions to cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] However, most of these studies except one have used a single internal thoracic artery, saphenous veins, or radial arteries as conduits, which could lead to decreased survival, increased reintervention and strokes due to manipulation of the aorta. 3,4 Further, MICS CABG has not shown good results in diabetics as in nondiabetics and the factors responsible could be the conduits used and incomplete revascularization. 5 The usage of bilateral internal thoracic arteries (BITAs) in CABG despite conclusive evidence of excellent long term outcomes of improving survival and lowering rates of reintervention and stroke has not been optimal and the main deterrent in their use during formal CABG has been the risk of sternal wound infection, markedly in obese diabetics and patients with chronic obstructive pulmonary disease.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Bilateral Internal Thoracic Arteries in Minimally Invasive Coronary Artery Bypass Grafting With Analogy to the SYNTAX Trial

Nambiar

Kumar

Mittal

et al. 2019

Innovations�(Phila)

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Objectives Minimally invasive CABG is making positive strides in the evolution of coronary artery bypass surgery. We carried out a retrospective study of the efficacy and outcomes of the usage of bilateral internal thoracic arteries in MICS CABG patients over a 6 year period using primary (MACCE) and secondary outcome measures and also carried out a subgroup analysis of patients with diabetes and methodology of revascularization, and with analogy to the SYNTAX trial of the relative risk. Methods Nine hundred and forty patients underwent multivessel MICS CABG via a left mini-thoracotomy from August 2011 to September 2017 and complete revascularization was done using the left internal thoracic artery–right internal thoracic artery Y (LITA–RITA Y) composite conduit. Efficacy and outcomes were evaluated by primary (MACCE) and secondary outcome measures including total length of stay, return to full physical activity, and quality of life. Propensity score matched analyses were carried out in diabetics, in the methodology of revascularization (MICS OPCABG vs. MICS ONCABG), and by comparison to the SYNTAX trial for relative risk. Mean follow-up was 2.9 years (maximum was 5.6 years). Results Out of the 940 patients, 843 (89.6%) were diabetic and 97 (10.4%) were nondiabetic. Average grafts were 3.2. There were 9 mortalities (0.9%). The average ICU and hospital stay was 40 ± 12 hours and 3.1 days. Ten patients (1.06%) required reintervention by angioplasty. A total of 99.3% patients were free from major adverse cardiac and cerebrovascular events (MACCE) at follow-up. Mean follow-up was 33 months and 846 (90%) of the patients were followed up. Based on propensity score–matched groups, patients who had their surgery done by MICS ONCABG (beating heart technique) had greater mean number of grafts and hospital length of stay and had significantly longer ICU stay, extubation in OR and blood loss in comparison to patients who had their CABG done by the MICS OPCABG technique. The new technique has shown favorable risk reduction in comparison to both the arms of the SYNTAX trial. Conclusions The safety, efficacy and outcomes of minimally invasive CABG evaluated by primary (MACCE) and secondary outcomes and quality-of-life measures have been good in this study, especially in diabetics, and have shown results better than conventional CABG. The learning curve can be safely negotiated by using peripheral cardiopulmonary bypass assistance and comparison with the SYNTAX trial has shown a relative reduction in all-cause risk.

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Minimally invasive coronary artery bypass grafting with bilateral internal thoracic arteries: Will this be the future?

Cited by 35 publications

References 19 publications

Multiple arterial, minimally invasive coronary surgery (MA-MICS)

Multiple arterial, minimally invasive coronary surgery (MA-MICS)

Complete Coronary Revascularization via Left Anterior Thoracotomy

Outcomes of Bilateral Internal Thoracic Arteries in Minimally Invasive Coronary Artery Bypass Grafting With Analogy to the SYNTAX Trial

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