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Early and follow-up angiography in minimally invasive coronary bypass without mechanical stabilization
I S Gill1, L A Higginson, G S Maharajh
1Department of Cardiothoracic Surgery, University of Ottawa Heart Institute, Ontario, Canada. gilli1@cesmtp.ccf.org
Insights
Minimally invasive coronary artery bypass surgery on a beating heart without mechanical stabilization shows excellent long-term graft patency and safety. This approach offers a safe and effective alternative for coronary revascularization.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Surgery
- Coronary Artery Bypass Grafting
Background:
- Assessing outcomes of coronary anastomosis performed on a beating heart without mechanical stabilization.
- Evaluating early and late results of off-pump coronary artery bypass (OPCAB) surgery.
- Investigating the safety and efficacy of coronary bypass without cardiopulmonary bypass.
Purpose of the Study:
- To evaluate the early and late outcomes of coronary anastomosis constructed on a beating heart without mechanical stabilization.
- To determine the safety and effectiveness of minimally invasive coronary bypass surgery.
- To assess graft patency and patient outcomes after off-pump coronary artery bypass.
Main Methods:
- Prospective study of 51 consecutive patients undergoing coronary artery bypass surgery on a beating heart.
- Utilized left minithoracotomy (39 patients) or median sternotomy (12 patients) with occlusive local snares.
- Performed early (100%) and late (63.5%) follow-up angiography at a mean of 9.6 months.
Main Results:
- Cumulative late graft patency was 95.4% (83/87 grafts).
- No early or late mortality or perioperative myocardial infarction observed.
- Two patients (3.9%) experienced recurrent angina; four anastomotic irregularities resolved.
Conclusions:
- Minimally invasive coronary bypass surgery on a beating heart is safe and effective.
- Early angiographic abnormalities require cautious interpretation; no long-term adverse effects of local snaring were found.
- Off-pump coronary artery bypass surgery demonstrates favorable long-term outcomes and safety.
Background:
This study was undertaken to assess the early and late outcome of coronary anastomosis constructed on a beating heart without the help of mechanical stabilization.
Methods:
All consecutive patients (51) from January 1996 to September 1997 who had bypass done by one surgeon using a left minithoracotomy (39) or median sternotomy (12) on a beating heart with occlusive local snares without mechanical stabilization underwent follow-up angiography early (100%) (within 6 hours) and late (63.5%) at a mean of 9.6+/-4.48 months (range, 3.3 to 19.1 months).
Results:
The cumulative late patency was 95.4% (83 of 87 patients), with two early and two late occlusions. There was no early or late mortality or perioperative myocardial infarction. Two patients (3.9%) developed recurrent angina. Four anastomotic irregularities (4 of 32 patients, 12.6%) have cleared up on follow-up angiography. There was no evidence of late stenosis at the snare sites used for local occlusion.
Conclusions:
Minimally invasive coronary bypass is safe and effective. Early angiographic abnormalities should be interpreted with caution and we could not demonstrate any long-term deleterious effects of local snaring.