Novel concept of routine total arterial coronary bypass grafting through a left anterior approach avoiding sternotomy

Dörge, Hilmar; Sellin, C.; Belmenai, Ahmed; Asch, Silke; Eggebrecht, Holger; Schächinger, Volker

doi:10.1007/s00380-022-02034-x

Cited by 9 publications

(9 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 CPB and cardiac arrest are essential prerequisites in the presented TCRAT technique. 10,11 We used a peripheral CPB cannulation strategy and transthoracic aortic cross-clamping, a technique adapted from minimally invasive mitral valve surgery, to achieve an unrestricted direct vision of the operation field through a small thoracic incision. Transthoracic cross-clamping from the left side was possible by pulling the ascending aorta with an encircling tape to the left.…”

Section: Discussionmentioning

confidence: 99%

“…We described the surgical technique in detail recently. 11 Patients were operated in a supine position. Minimal invasive harvesting of RA was performed using an endoscopic reusable retractor (Bisleri Model, Karl Storz, Tuttlingen, Germany) and a bipolar radiofrequency vessel sealing system (LigaSure; Medtronic, Minneapolis, Minnesota, United States) via a 2-cm distal incision of the forearm.…”

Section: Methodsmentioning

confidence: 99%

“…We introduced this minimally invasive technique to our clinical routine and recently described the technical details. 11 This report presents perioperative data as well as in-hospital outcomes of our initial series of patients.…”

Section: Introductionmentioning

confidence: 99%

“…Babliak et al 10 proposed a new operative approach via a small left anterior thoracotomy, based on long proven cardiac surgery concepts for revascularization in multivessel coronary disease combined with technical aspects known from minimally invasive valve surgery, and named the procedure “total coronary revascularization via left anterior thoracotomy (TCRAT).” We introduced this minimally invasive technique to our clinical routine and recently described the technical details. 11 This report presents perioperative data as well as in-hospital outcomes of our initial series of patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Early Results of Total Coronary Revascularization via Left Anterior Thoracotomy

Sellin

Asch

Belmenai

et al. 2022

Thorac Cardiovasc Surg

Self Cite

View full text Add to dashboard Cite

Background Avoidance of sternotomy while preserving complete revascularization remains challenging in multivessel coronary disease. Technical issues and in-hospital outcomes of total coronary revascularization via a small left anterior thoracotomy (TCRAT) in nonselected patients with multivessel disease are reported. Methods From November 2019 to September 2021, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed in 102 patients (92 males; 67 ± 10 [42–87] years). Slings were placed around ascending aorta, left pulmonary veins, and inferior vena cava for exposure of lateral and inferior ventricular wall. All patients had multivessel coronary disease (three-vessel disease: n = 72; two-vessel disease: n = 30; left main stenosis: n = 44). We included patients at old age (> 80 years, 14.7%), with severe left ventricular dysfunction (ejection fraction < 30%, 6.9%), massive obesity (body mass index > 35, 11.6%), and at increased risk (EuroSCORE II > 4, 15.7%). Results Left internal thoracic artery (n = 101), radial artery (n = 83), and saphenous vein (n = 39) grafts were used for total (61.8%) or multiple (19.6%) arterial grafting. A total of 323 distal anastomoses (3.2 ± 0.7 [2–5] per patient) were performed to revascularize left anterior descending (100%), circumflex (91.2%), and right coronary artery (67.7%). Complete revascularization was achieved in 95.1%. In-hospital mortality was 2.9%, stroke rate was 1.0%, myocardial infarction rate was 2.9%, and repeat revascularization rate was 2.0%. Conclusion This novel surgical technique allows complete coronary revascularization in the broad majority of multivessel disease patients without sternotomy. TCRAT can be introduced into clinical routine safely. Long-term results remain to be investigated.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early Results of Total Coronary Revascularization via Left Anterior Thoracotomy

Sellin

Asch

Belmenai

et al. 2022

Thorac Cardiovasc Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…Minimally invasive techniques that do not require conventional sternotomy seem to be the most promising options in cardiac surgery in obese patients: In mitral valve surgery, lateral mini thoracotomy becomes more and more common[ 28 ], and catheter techniques [ 29 ] or robotic surgery are emerging [ 30 ]. In aortic valve disease, the ongoing discussion about the indications between transcatheter aortic valve implantations and conventional approaches via sternotomy [ 31 ] should be[ 32 ] extended[ 33 ] and obese[ 34 ] patients should be treated.…”

Section: Discussionmentioning

confidence: 99%

The Burden of Obesity in Cardiac Surgery: A 14 years’ Follow-Up of 14.754 Patients

Beckmann,

Poehlmann,

Mayr

et al. 2024

Journal of Obesity

View full text Add to dashboard Cite

Aims. The prevalence of obesity is rapidly increasing during the past decades. While previous research has focused on the early outcome after cardiac surgery or specific complications, the current study covers the whole burden of obesity in the field of cardiac surgery over short term and long term. Endpoints of the study were all-cause mortality, perioperative outcome, and wound-healing disorders (WHDs). Methods. 14.754 consecutive patients who underwent cardiac surgery over a 14 years’ time period were analyzed. BMI classifications were used according to the WHO definition. Results. Mean survival was 11.95 years ± 0.1; CI 95% [12.04–12.14]. After adjustment for clinical baseline characteristics, obesity classes’ I–III (obesity) did not affect 30-day mortality or all-cause mortality during the whole observational period. After adjustment for known risk factors, the risk for WHDs doubled at least in obesity patients as follows: obesity I (OR = 2.06; CI 95% [1.7–2.5]; p<0.0001), obesity II (OR = 2.5; CI 95% [1.83–3.41]; p<0.0001), and obesity III (OR = 4.12; CI 95% [2.52–6.74]; p<0.0001). The same applies to the risk for sternal reconstruction that is substantially elevated in obesity I (OR = 2.23; CI 95% [1.75–2.83]; p<0.0001), obesity II (OR = 2.81; CI 95% [1.91–4.13]; p<0.0001), and obesity III (OR = 2.31; CI 95% [1.08–4.97]; p=0.03). No significant correlation could be found between obesity and major adverse events in the perioperative course like renal failure, ventilation >24 h, re-exploration, or cerebrovascular events. Conclusions. Cardiac surgery is safe in obesity as short- and long-term mortality are not increased, and major adverse events during the perioperative course are similar to control patients. The burden of obesity lies in substantially increased rates of wound-healing disorders and sternal reconstructions.

show abstract