Minimally invasive coronary artery bypass grafting: useful routine option for coronary revascularization in selected cas
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ORIGINAL ARTICLE
Minimally invasive coronary artery bypass grafting: useful routine option for coronary revascularization in selected cases Taichi Sakaguchi1 · Toshinori Totsugawa2 · Kentaro Tamura2 · Arudo Hiraoka2 · Masaaki Ryomoto1 · Naosumi Sekiya1 · Genta Chikazawa2 · Hidenori Yoshitaka2 Received: 16 December 2019 / Accepted: 7 March 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objectives The safety and feasibility of minimally invasive coronary artery bypass grafting (MICS CABG) were evaluated. Methods From December 2012 to March 2019, 122 consecutive patients underwent MICS CABG via a left mini-thoracotomy under direct vision. The internal thoracic artery (ITA) was harvested from all, while bilateral ITAs (BITAs) were used in 36 patients, with the second ITA as an in situ (n = 18) or free (n = 18) graft. Proximal anastomosis of the free graft (ITA, radial artery, or saphenous vein segments) was performed directly onto the ascending aorta, or from the ITA as a Y- or I-composite graft. Results Patient ages ranged from 38 to 89 years (mean 66.9 ± 9.6 years) and 102 were males. MICS CABG was completed without conversion in 116 patients (95.1%), of whom 76 underwent multivessel bypass grafting, with 2 grafts used in 52 and 3 or more in 24 patients. A cardiopulmonary bypass was performed in 17 patients. Perioperative mortality occurred in 1 patient who died of advanced cancer. There were no cases of reoperation for bleeding, stroke, or chest wound infection. The perioperative transfusion rate was 11.2%. Early graft patency was noted in 97.1%. The rate of freedom from major adverse cardiac and cerebrovascular events (all-cause death, myocardial infarction, stroke, and repeated revascularization) was 89.7% at 5 years. Conclusions MICS CABG is feasible and showed good mid-term outcomes. BITAs can be harvested with this approach; thus, allowing for various graft designs. We recommend this as a useful option for coronary revascularization in selected cases. Keywords Minimally invasive cardiac surgery · Coronary artery bypass grafting · Off-pump coronary artery bypass grafting · Bilateral internal thoracic arteries · Hybrid coronary revascularization
Introduction Minimally invasive cardiac surgery (MICS) through a small thoracotomy has various advantages over a conventional sternotomy in terms of superior cosmesis, lower chance of bleeding or wound infection, and faster recovery, thus Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11748-020-01336-z) contains supplementary material, which is available to authorized users. * Taichi Sakaguchi t‑sakaguchi@hyo‑med.ac.jp 1
Department of Cardiovascular Surgery, Hyogo College of Medicine, 1‑1 Mukogawa‑cho, Nishinomiya, Hyogo 663‑8501, Japan
The Sakakibara Heart Institute of Okayama, 2‑5‑1 Nakai‑cho, Okayama 700‑0804, Japan
2
is increasingly employed as a routine approach, especially for valve surgery [1]. However, for surgical coronary revascularization, coronary artery bypass grafting (
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