Nonsternotomy multivessel coronary artery bypass grafting: A key development in cardiac surgery

Ruel, Marc

doi:10.1016/j.xjtc.2021.09.033

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…Minimally invasive coronary surgery (MICS CABG) was developed as an extension of the MIDCAB operation and implies multivessel grafting through a limited left anterior thoracotomy ( 86 , 87 ). A further development of this approach is the robotic total endoscopic coronary artery bypass (TECAB) technique which provides multivessel revascularization without an open incision through port access ( 86 ).…”

Section: Intraoperative Choices For Frail Patients: the Right Strateg...mentioning

confidence: 99%

The frail patient undergoing cardiac surgery: lessons learned and future perspectives

Pozzi,

Mariani,

Scanziani

et al. 2023

Front. Cardiovasc. Med.

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Frailty is a geriatric condition characterized by the reduction of the individual's homeostatic reserves. It determines an increased vulnerability to endogenous and exogenous stressors and can lead to poor outcomes. It is an emerging concept in perioperative medicine, since an increasing number of patients undergoing surgical interventions are older and the traditional models of care seem to be inadequate to satisfy these patients' emerging clinical needs. Nowadays, the progressive technical and clinical improvements allow to offer cardiac operations to an older, sicker and frail population. For these reasons, a multidisciplinary team involving cardiac surgeons, clinical cardiologists, anesthesiologists, and geriatricians, is often needed to assess, select and provide tailored care to these high-risk frail patients to optimize clinical outcomes. There is unanimous agreement that frailty assessment may capture the individual's biological decline and the heterogeneity in risk profile for poor health-related outcomes among people of the same age. However, since commonly used preoperative scores for cardiac surgery fail to capture frailty, a specific preoperative assessment with dedicated tools is warranted to correctly recognize, measure and quantify frailty in these patients. On the contrary, pre-operative and post-operative interventions can reduce the risk of complications and support patient recovery promoting surgical resilience. Minimally invasive cardiac procedures aim to reduce surgical trauma and may be associated with better clinical outcome in this specific sub-group of high-risk patients. Among postoperative adverse events, the occurrence of delirium represents a risk factor for several unfavorable outcomes including mortality and subsequent cognitive decline. Its presence should be carefully recognized, triggering an adequate, evidence based, treatment. There is evidence, from several cross-section and longitudinal studies, that frailty and delirium may frequently overlap, with frailty serving both as a predisposing factor and as an outcome of delirium and delirium being a marker of a latent condition of frailty. In conclusion, frail patients are at increased risk to experience poor outcome after cardiac surgery. A multidisciplinary approach aimed to recognize more vulnerable individuals, optimize pre-operative conditions, reduce surgical invasivity and improve post-operative recovery is required to obtain optimal long-term outcome.

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Section: Intraoperative Choices For Frail Patients: the Right Strateg...mentioning

confidence: 99%

The frail patient undergoing cardiac surgery: lessons learned and future perspectives

Pozzi,

Mariani,

Scanziani

et al. 2023

Front. Cardiovasc. Med.

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“…To optimize exposure of the lateral wall, the shaft was removed from the Starfish positioner, and an umbilical tape tied around its base was used to apply traction toward the patient’s right hip. 6 The SVG was anastomosed to the obtuse marginal artery ( Supplemental Video 2 ), with a flow of 35 mL/min and pulsatility index of 1.5 confirmed with a transit-time flow meter (Medistim, Oslo, Norway). The LITA was then anastomosed to the LAD with flow of 18 mL/min and pulsatility index of 2.…”

Section: Case Reportmentioning

confidence: 99%

Minimally Invasive Coronary Artery Bypass Grafting in a Patient With Chronic Tracheostoma: Alternative to Reduce Sternal Wound Complication Risk

Nantsios

Elmistekawy

Ponnambalam

et al. 2022

Innovations�(Phila)

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Patients with chronic tracheostoma present a challenge when they require coronary bypass surgery due to an elevated risk of sternal wound infections (SWI). Minimally invasive coronary artery bypass grafting (MICS CABG) is a robust technique that allows complete surgical revascularization while mitigating the risks of sternal complications and functional decline associated with sternotomy. In such patients at elevated risk for SWI, MICS CABG may represent a viable revascularization strategy to avoid sternotomy. Here, we present a case of a frail, comorbid patient with a chronic tracheostomy and symptomatic multivessel coronary artery disease not amenable to percutaneous therapy referred for MICS CABG.

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“…3,4 However, it has been recognized that MICS is technically more demanding and has a steep learning curve to overcome. 5 A surgeon is required to master off-pump CABG (OPCAB), followed by single-vessel MICS, before embarking into multivessel MICS. 6 The lengthy learning process is discouraging to some surgeons.…”

Section: Introductionmentioning

confidence: 99%

Self-Practice Program for Beating-Heart Minimally Invasive Coronary Anastomosis Using a Homemade Low-Fidelity Simulator: A Proof of Concept

Azmi,

Nair,

Hashim

2024

Innovations�(Phila)

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Objective: We evaluated the effectiveness of a consistent and structured self-practice coronary anastomosis program using a homemade low-fidelity beating-heart simulator. Methods: An intermediary trainee was subjected to an 8-week structured self-practice program. The program was divided into 2 parts of nonbeating and beating practices with a minimum number of timed anastomoses. Each part was followed by an assessment using an objective skills assessment tool score. The beating-heart simulator was built using motorized toy blocks connected wirelessly to a smartphone application. This was coded to enable rate selection. A junior consultant was compared to the subject at the end of the program. Both were tasked to perform 1 coronary anastomosis for both off-pump coronary artery bypass (OPCAB) and minimally invasive CAB (MICS) setup. The primary outcomes were anastomotic time and score compared with the junior consultant. Secondary outcomes were progression of anastomotic time and score throughout the program. Results: Overall performance of the studied subject approached the performance of the junior consultant in terms of time (OPCAB, 489 vs 605 s; MICS, 712 vs 652 s) and scores (OPCAB, 21 vs 20.7; MICS, 19 vs 20.6). There were inverse correlations between anastomosis time and number of practices for both nonbeating and beating anastomoses. Overall improvement was observed in terms of assessment scoring by 26.6%. Conclusions: A structured self-practice program using an affordable and accessible simulator was able to help trainees overcome the MICS anastomosis learning curve quicker when introduced earlier. This may encourage earlier adoption of MICS among surgeons.

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Nonsternotomy multivessel coronary artery bypass grafting: A key development in cardiac surgery

Cited by 9 publications

References 22 publications

The frail patient undergoing cardiac surgery: lessons learned and future perspectives

The frail patient undergoing cardiac surgery: lessons learned and future perspectives

Minimally Invasive Coronary Artery Bypass Grafting in a Patient With Chronic Tracheostoma: Alternative to Reduce Sternal Wound Complication Risk

Self-Practice Program for Beating-Heart Minimally Invasive Coronary Anastomosis Using a Homemade Low-Fidelity Simulator: A Proof of Concept

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