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Multiple minimally invasive direct coronary artery bypass grafting for the complete revascularization of the left
G Watanabe1, T Misaki, K Kotoh
1Department of Surgery, Toyama Medical and Pharmaceutical University, Japan.
Insights
Minimally invasive coronary artery bypass grafting using multiple arterial grafts offers a feasible alternative for total left ventricle revascularization. This approach demonstrated excellent early graft patency without complications in patients with complex coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Arterial Grafting
Background:
- Minimally invasive single-vessel coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery is effective but limited to single-vessel disease.
- Patients with double- or triple-vessel disease require alternative revascularization strategies.
- The study aimed to develop a minimally invasive CABG technique for total left ventricular revascularization using multiple arterial grafts without cardiopulmonary bypass.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a minimally invasive direct coronary artery bypass grafting (MIDCABG) technique for total revascularization in patients with multi-vessel coronary artery disease.
- To assess the efficacy of using multiple arterial grafts in a beating-heart approach through a limited thoracotomy.
Main Methods:
- A limited lateral thoracotomy approach was utilized to access the LAD and left circumflex coronary arteries.
- Two to three arterial grafts were harvested and anastomosed to target coronary arteries in 20 patients, with 4 patients undergoing triple- or quadruple-vessel grafting.
- The procedure was performed without cardiopulmonary bypass, employing complex arterial grafts.
Main Results:
- Mean coronary cross-clamp times were 14.5 ± 4.0 minutes for the LAD and 16.8 ± 5.1 minutes for the left circumflex.
- No early deaths or postoperative complications were observed.
- Postoperative coronary angiography confirmed widely patent grafts in all patients, with no late deaths or angina during a mean follow-up of 7.0 months.
Conclusions:
- Minimally invasive multiple coronary artery bypass grafting via limited thoracotomy is technically feasible for complete left ventricular revascularization.
- This approach may serve as a viable alternative for selected patients with complex coronary artery disease.
- Mechanical immobilization of the coronary artery is crucial for enhancing early graft patency.
Background:
Single-vessel coronary artery bypass grafting of the left internal mammary artery to the left anterior descending coronary artery using a minithoracotomy has been shown to produce excellent results with a very low mortality rate. However, this procedure cannot be used in patients with double- or triple-vessel disease. Our goal was to develop a minimally invasive direct coronary artery bypass grafting without cardiopulmonary bypass for total revascularization of the left ventricle using multiple arterial grafts.
Methods:
Limited lateral thoracotomy was performed in the fourth or fifth intercostal spaces, exposing the left anterior descending coronary artery and left circumflex coronary artery. Two or three arterial grafts were harvested. Revascularization of the left anterior descending coronary artery and the left circumflex coronary artery were performed in 20 patients without cardiopulmonary bypass through the limited lateral thoracotomy using complex performed arterial grafts. In 4 patients, triple- and quadruple-vessel grafting was performed.
Results:
The mean coronary cross-clamp time was 14.5+/-4.0 minutes for the left anterior descending coronary artery and 16.8+/-5.1 minutes for the left circumflex coronary artery. No early deaths or postoperative complications occurred. There were no late deaths or angina during the mean follow-up of 7.0 months (range, 2 to 22 months). Postoperative coronary angiography demonstrated widely patent grafts in all patients.
Conclusions:
Minimally invasive approach through a limited thoracotomy in multiple coronary artery bypass graftings are technically feasible and may be an alternative approach in the complete revascularization of the left ventricle. Mechanical immobilization of the coronary artery enhances early graft patency and is an essential part of this procedure.