Ninety-seven cases of experiences with the left thoracotomy approach for off-pump conventional revascularization: a retrospective cohort study

Abstract

Background: Minimally invasive coronary surgery-coronary artery bypass grafting (MICS CABG) is well adopted in clinical practice. However, this procedure did not really achieve conventional complete revascularization. The present study aimed to explore the feasibility and safety of conventional revascularization via the left thoracotomy (8-10 cm) approach.Methods: From January 2020 to March 2022, a total of 97 consecutive patients who needed coronary artery revascularization were operated on using this technique. The patients' preoperative, intraoperative, postoperative, and follow-up data were collected. Perioperative variables were compared between the single graft and non-single graft groups. All patients received dual-source computerized tomographic angiography at 1-week postoperatively to evaluate the graft patency and detect pulmonary embolism and aortic dissection.The patients were followed up for 3-27 months. Results:The mean age of the entire cohort was 61.5±8.8 years, there were 16 (16.5%) female patients, and 1-4 grafts were performed per patient. There were no conversions to median sternotomy or on-pump CABG. The average number of grafts was 1.9±0.9, and that of the non-single graft group was 2.5±0.6. Among the 97 included patients, one patient in the single graft group suffered from aspiration pneumonia after a stroke and died. The 30-day mortality was 1.0% (one patient), one patient required re-exploration for bleeding (1.1%), and a total of 191 grafts were performed. All grafts were unobstructed except for one graft to the obtuse marginal branch (OM) (0.5%). Follow-up was performed by phone or via outpatient visits and was available for 92 patients (95%). During the follow-up period, 1 (1.1%) patient suffered an acute myocardial infarction and received percutaneous coronary intervention with no redo-surgery. All patients are alive and angina-free.Conclusions: Left thoracotomy for conventional revascularization is a safe procedure for appropriately selected patients, with few early complications and good early and mid-term results. More cases are ongoing and long-term results are in observation.

Off-pump minimally invasive coronary artery bypass grafting in patients with left ventricular dysfunction: the lampang experience

“…However, as mentioned above, no study has examined the safety of MICSOPCAB in patients with impaired LV function; therefore, whether low EF should be included in patient selection is still unclear. In the present series, MICSOPCAB showed significant differences in the ICU stay (2 [1][2] in the Low EF group vs. 1 [1][2] in the Normal EF group; p = 0.010) and perioperative transfusions (69.7% in the Low EF group vs. 49.2% in the Normal EF group; p = 0.023) but did not compromise hospital stay or complication rates in patients with low EF, comparable to other recent studies (1,2,4,17). Based on the results of the present study, we advocated that low EF should not be identified as an absolute contraindication for MICSOPCAB.…”

“…Regarding multivessel arterial grafting, MICSOPCAB is also evolving. Harvesting bilateral internal mammary arteries via left small thoracotomy has been challenging; however, their safety has improved in recent years (4,17). This study used bilateral internal mammary arteries in 15 patients.…”

“…MICSOPCAB has advantages over conventional off-pump coronary artery bypass (OPCAB) via median sternotomy, e.g., better cosmetics, less bleeding, and rapid recovery (1,2). However, MICSOPCAB is technically difficult; therefore, previous studies have indicated that MICSOPCAB should be contraindicated in patients with impaired left ventricular (LV) function (3)(4)(5). Our institute has performed MICSOPCAB as a standard procedure in selected patients with favorable coronary anatomy regardless of LV function.…”

Multi-vessel coronary artery grafting: analyzing the minimally invasive approach and its safety

“…The concept of surgical revascularization through a left thoracic minimal incision stepped up from single bypasses to multiple bypasses with total arterial grafting using BITA ( 3 , 14 , 15 ). Kikuchi and colleagues analyzed short-term outcomes of MICS-OPCAB using BITA and a single internal thoracic artery (SITA) at a single Japanese medical center between February 2012 and December 2015 ( 15 ).…”

“…Minimally invasive direct coronary artery bypass grafting (MIDCAB) ( 1 ) was popularized in the 1990s. Nowadays, multivessel coronary artery bypass grafting (CABG) via a left small thoracotomy has developed as a minimally invasive cardiac surgery coronary artery bypass (MICS-CABG) and maintained gaining attention ( 2 , 3 ). In our institution, we have performed off-pump coronary artery bypass (OPCAB) as a standard procedure, and patients with favorable coronary anatomy and condition are selected for MICS-OPCAB.…”