Postoperative Early Outcomes of Conventional versus Minimally Invasive Multivessel Coronary Artery Bypass Surgery: Retrospective Study

Erdoğan, Elif; Gokarslan, Gokhan; Uygur, Feragat; Yardımcı, Murat; Kaya, Erkan; Sariguney, Damla

doi:10.30702/ujcvs/21.4512/eg054-3035

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…Safety of TCRAT is proved by our results (7) obtained from the series of consecutive patients starting from the first one, which represents 93.7% of patients presented to our hospital for isolated CABG. Regarding reproducibility, TCRAT have been successfully implemented in many countries around the world since our first international presentation in 2018 (14,15).…”

Section: Discussionmentioning

confidence: 99%

Multivessel minimally invasive on-pump direct coronary artery revascularization

Babliak¹,

Demianenko²,

Marchenko³

et al. 2023

J Vis Surg

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Background: Our aim was to describe the technique of minimally invasive on-pump multivessel coronary revascularization through the left anterior thoracotomy, evaluate the intraoperative and early postoperative results.Methods: In this single-center retrospective cohort study we investigated the outcomes of 521 consecutive patients with isolated multivessel coronary artery disease (CAD) who were operated from July 2017 to December 2021. All operations performed via the left anterior minithoracotomy through the fourth intercostal space. Transthoracic clamp and blood cardioplegia were used for heart arrest and special maneuvers for coronary exposition. This technique was named total coronary revascularization via left anterior thoracotomy (TCRAT). Results:The mean number of grafts was 2.97±0.7 [range, 2-5]. Left internal mammary artery (LIMA) was used in 494 (94.8%) patients, the right internal mammary artery (RIMA) in 10 (1.9%) patients, radial artery in 153 (29.4%) patients, and veins in 429 (82.3%) patients. In our series the mortality rate was 0.57% (3 cases), 2 (0.38%) conversions to sternotomy due to acute aortic dissection and no postoperative myocardial infarctions were observed. There were 2 (0.38%) postoperative strokes and 6 (1.15%) revisions for postoperative bleeding without conversion to sternotomy. The total operation time was 269±51.8 minutes, cardiopulmonary bypass time 145.7±33.5 minutes, and aortic cross-clamp time 71.9±19.9 minutes. The mean intensive care stay was 2.1±1.2 days and mean total hospital stay 5.9±2.2 days Conclusions: The TCRAT technique could be used as a routine method of coronary artery bypass grafting (CABG) and provide the possibility to fully eliminate sternotomy for almost all patients (except porcelain aorta) with isolated multivessel CAD. Special surgical maneuvers for coronary targets exposure have made TCRAT more universal in practice than other minimally invasive CABG techniques. This technique preserves principles of complete coronary revascularisation and is applicable for multivessel CABG with use of standard coronary instruments and anastomotic techniques.

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Section: Discussionmentioning

confidence: 99%

Multivessel minimally invasive on-pump direct coronary artery revascularization

Babliak¹,

Demianenko²,

Marchenko³

et al. 2023

J Vis Surg

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Left anterior minithoracotomy as a first-choice approach for isolated coronary artery bypass grafting and selective combined procedures

Babliak¹,

Demianenko²,

Marchenko³

et al. 2023

European Journal of Cardio-Thoracic Surgery

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Objective To describe the technique and evaluate the results of the isolated coronary artery bypass grafting or combined grafting procedures with mitral valve repair/replacement and/or left ventricle aneurysm repair performed through the single left anterior minithoracotomy. Methods Perioperative data of all patients, who required isolated or combined coronary grafting from July 2017 to December 2021 were observed. The focus was on 560 patients, who underwent isolated or combined multivessel coronary bypass using “Total Coronary Revascularization via left Anterior Thoracotomy” technique. Main perioperative outcomes were analysed. Results Left anterior minithoracotomy was used in 521 (97.7%) out of 533 patients, who required isolated multivessel surgical coronary revascularization, and in 39 (32.5%) out of 120 patients, who required combined procedures. In 39 patients multivessel grafting was combined with 25 mitral valve and 22 left ventricular procedures. Mitral valve repair was performed through the aneurysm (n = 8) or through the interatrial septum (n = 17). Perioperative outcomes in isolated and combined groups were next: aortic cross-clamp time - 71.9 (SD: 19.9) and 120 (SD: 25.8) min, cardiopulmonary bypass time - 145.7 (SD: 33.5) and 216 (SD: 45.8) min, total operation time - 269 (SD: 51.8) and 324 (SD: 52.1) min, intensive care stay – 2(2-2) and 2(2-2) days, total hospital stay – 6(5-7) and 6(5-7) days, total 30-days mortality was 0.54 and 0% respectively. Conclusion Left anterior minithoracotomy can be effectively used as a first-choice approach to perform isolated multivessel coronary grafting and combined with mitral valve and/or left ventricular repair. Experience with isolated coronary grafting through the anterior minithoracotomy is required to achieve the satisfactory results in combined procedures.

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Postoperative Early Outcomes of Conventional versus Minimally Invasive Multivessel Coronary Artery Bypass Surgery: Retrospective Study

Cited by 2 publications

References 30 publications

Multivessel minimally invasive on-pump direct coronary artery revascularization

Multivessel minimally invasive on-pump direct coronary artery revascularization

Left anterior minithoracotomy as a first-choice approach for isolated coronary artery bypass grafting and selective combined procedures

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