Video Assisted Coronary Bypass Surgery

Benetti, Federico; Ballester, Carlos; Sani, Guido; Doonstra, Pict; Grandjean, Jan G.

doi:10.1111/j.1540-8191.1995.tb00651.x

Cited by 190 publications

(60 citation statements)

References 6 publications

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“…However, cardiopulmonary bypass is a well-recognized factor for generating a whole-body inflammatory response, which can contribute to postoperative morbidity including renal, pulmonary, neurological and bleeding complications (1,2). Benetti et al (3) and Buffolo et al (4) reintroduced beating heart surgery almost 20 years ago as a strategy to prevent complications in high-risk patients. Since that time, off-pump coronary artery bypass (OPCAB) surgery has gained increasing popularity and is challenging conventional on-pump coronary artery bypass (CCAB) as the standard of therapy for multivessel disease in many cardiac centres (2).…”

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confidence: 99%

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Ivanov

Borger

et al. 2008

Canadian Journal of Cardiology

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C oronary artery disease is associated with more death and disabilities than any other disease in industrialized nations. Coronary artery bypass graft surgery (CABG) is one of the most effective methods of treating symptomatic coronary artery disease and is performed in approximately 10,000 patients annually in Ontario.The majority of cardiac operations require the establishment of cardiopulmonary bypass and cardioplegic arrest. However, cardiopulmonary bypass is a well-recognized factor for generating a whole-body inflammatory response, which can contribute to postoperative morbidity including renal, pulmonary, neurological and bleeding complications (1,2). Benetti et al (3) and Buffolo et al (4) reintroduced beating heart surgery almost 20 years ago as a strategy to prevent complications in high-risk patients. Since that time, off-pump coronary artery bypass (OPCAB) surgery has gained increasing popularity and is challenging conventional on-pump coronary artery bypass (CCAB) as the standard of therapy for multivessel disease in many cardiac centres (2).The benefits of OPCAB remain controversial, despite the publication of numerous studies reporting equivalent or improved hospital outcomes and significantly shorter lengths of hospital stay. Ascione and Angelini (5) discussed the dilemma faced by many cardiac surgeons who perform CABG. On one hand, the literature is replete with studies that emphasize the potential for reducing postoperative morbidity and length of stay with OPCAB surgery (6-24); on the other hand, there is continued concern regarding intraoperative myocardial ischemia, inadequate revascularization and the need for early revascularization (5,8,23,(25)(26)(27)(28)(29).Therefore, the purpose of the present study was to evaluate midterm outcomes of OPCAB versus conventional CCAB in two wellmatched cohorts. CLINICAL STUDIES©2008 Pulsus Group Inc. All rights reserved OBJECTIVE: To evaluate survival and readmissions to hospital for cardiac events or coronary revascularization (REVASC) in patients having off-pump (OPCAB) versus conventional on-pump (CCAB) coronary artery bypass graft surgery (CABG). METHODS: Of 11,368 consecutive patients undergoing isolated CABG between 1996 and 2002, 514 had OPCAB surgery. Using propensity scores, 503 CCAB patients were randomly matched to 503 OPCAB patients. RESULTS: There were no clinical or statistical differences between the two groups for any prognostic variable. However, OPCAB patients received significantly fewer distal anastomoses than the CCAB group (2.6±1.0 versus 3.1±1.0; P<0.001). There was no difference in operative mortality (OPCAB 1.0%, CCAB 1.4%; P=0.6), but the OPCAB group had significantly fewer operative strokes (0.2% versus 1.8%; P=0.01). Follow-up was 99.7% complete at 2.2±1.2 years (range 0 to 6 years). Twice as many OPCAB patients (n=24) required REVASC compared with the CCAB (n=11) group. The following five-year actuarial outcomes are presented for CCAB and OPCAB, respectively: survival: 77±6%, 76±8%, P=0.8; freedom from REVASC: 95±3%, 92±2%, ...

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confidence: 99%

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Ivanov

Borger

et al. 2008

Canadian Journal of Cardiology

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“…The "LAST" operation undoubtedly represents a good option also in patients with previous myocardial revascularization without the use of mammary artery. Excellent results have been repeatedly reported by different groups [1,7,8,9] and patency rate of the LIMA to LAD anastomosis above 95% has been documented [10].…”

Section: Discussionmentioning

confidence: 68%

The use of â€œLASTâ€ operation in high risk patient

Ismeno

Falco

Tritto

et al. 2016

Monaldi Arch Chest Dis

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Surgical revascularization of the Left AnteriorDescending coronary artery (LAD) with the Left Internal Mammary Artery (LIMA) can be carried out through a left anterior small thoracotomy without cardiopulmonary bypass as a beating heart (LAST operation). This approach is quite appealing to the patients due to minimal invasiveness, short hospital stay and quick recovery.The LAST operation, introduced and popularised by Calafiore et al. [1] can be considered nowadays a good option for patients with an isolated proximal LAD lesion not favourable for PTCA (total obstruction or type C lesion) or in care of recurrent stenosis following PTCA. However there are few drawbacks related to the LAST operation. First of all harvesting of the LIMA is technically demanding when is performed through a small anterior thoracotomy and the arterial conduit can be occasionally traumatised and/or irreversibly damaged. Furthermore, due to a difficult exposure, the branches of the upper portion of the LIMA are usually not divided and this might produce a steal phenomenon with recurrent angina in spite of a patent LIMA graft [2].Finally, the LAST operation has to be occasionally converted into a midline sternotomy procedure because the LAD is not appropriately identified or exposed through a small thoracotomy as is running intramurally as is diffuses diseases and an endoarterectomy can be required.In this study we report our preliminary experience with the use of LAST operation in high risk patients. An incision of about 6 cm was made in the appropriate intercostal space and the LIMA (Left Internal Mammary Artery) was harvested using a special costal retractor. After heparin administration the LIMA is distally divided to check the adequacy of the blood flow. Following the insertion of a temporary intracoronary shunt, the LIMA was LAD anastomosis was carried out with a continuous 8-0 polypropylene suture. Matherial and Metods The patientsResults: No hospital or late mortality was observed. Uneventful conversion to midline sternotomy was necessary in one patient with low value of mammary flow. All patients were discharged within the first postoperative week.Conclusions: The use of the LAST operation enhances the role of minimally invasive surgery also in high risk patients who need coronary revascularization.

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“…Intraoperative flow measurement can be recommended to assess graft flow, especially in the left internal mammary artery (IMA) to the left anterior descending artery (LAD) [1]. In MIDCAB procedures, some additional difficulties due to restricted access or cardiac motion may compromise the quality of the anastomosis [2,3,8]. Several reports on the use of volume flow measurements during cardiac surgery with the transit time method have been previously published [4,[7][8][9][10] …”

Section: Introductionmentioning

confidence: 99%

Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement

Walpoth

Bosshard

Kipfer

et al. 1998

European Journal of Cardio-Thoracic Surgery

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Objectives: To assess intraoperative flow of arterial and venous coronary grafts after myocardial revascularization which may allow early detection of low flow situations, especially during minimally invasive coronary bypass surgery (MIDCAB), and lead to immediate correction of technical problems. Methods: In two patients with severe and diffuse multi-vessel disease the left internal mammary artery (IMA) was connected to the left anterior descending artery (LAD). During reperfusion, the flow was measured in the IMA and vein grafts using a transit time flow meter. Results: In both cases the IMA showed only a systolic pendulating flow curve with a mean flow of 0-1 ml/ min and a high resistance. Manual IMA assessment revealed an adequate pulsation. Both distal IMA anastomoses were re-explored on cardiopulmonary bypass yielding an initial flow of 7 and 14 ml/min, respectively. After treatment with papaverine/adenosine the IMA flow increased from 7 to 26 ml/min (coronary flow reserve (CFR) = 3.7) and from 14 to 46 ml/min (CFR = 3.3), respectively. Conclusion: Intraoperative flow assessment of IMA and venous bypass grafts can be recommended to monitor flow; especially during MIDCAB procedures.

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Video Assisted Coronary Bypass Surgery

Cited by 190 publications

References 6 publications

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

The use of â€œLASTâ€ operation in high risk patient

Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement

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Video Assisted Coronary Bypass Surgery

Cited by 190 publications

References 6 publications

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery

The use of â€œLASTâ€ operation in high risk patient

Failed coronary artery bypass anastomosis detected by intraoperative coronary flow measurement

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The use of â€œLASTâ€ operation in high risk patient