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A xiphoid approach for minimally invasive coronary artery bypass surgery
F Benetti1, M K Dullum, S C Stamou
1Benetti Foundation, Rosario, Argentina.
Insights
The xiphoid approach enables safe minimally invasive direct coronary artery bypass surgery, reducing patient morbidity and hospital stay. This technique offers a viable alternative for myocardial revascularization with excellent outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Surgical Approaches
Background:
- Minimally invasive cardiac surgery aims to reduce patient morbidity during myocardial revascularization.
- Opening the pleura is a significant limitation in current minimally invasive approaches.
- The xiphoid approach is explored to overcome pleural entry limitations.
Purpose of the Study:
- To evaluate the xiphoid approach for minimally invasive coronary artery bypass surgery.
- To minimize postoperative pain and complications.
- To assess the efficacy and safety of this surgical technique.
Main Methods:
- Retrospective review of 55 patients undergoing minimally invasive direct coronary artery bypass (MIDCAB) via xiphoid approach.
- Internal mammary artery (IMA) harvesting using thoracoscopy or direct vision.
- Analysis of patient demographics, surgical procedures, and outcomes.
Main Results:
- Low incidence of postoperative complications: atrial fibrillation (12%), pericarditis (12%), renal failure (5%).
- Mean postoperative length of stay was 4 days.
- No operative mortality and 98% actuarial survival at mean 11-month follow-up, with excellent anastomotic patency.
Conclusions:
- The xiphoid approach is a safe and effective method for minimally invasive coronary artery bypass.
- This technique offers low morbidity and mortality rates.
- It results in a relatively short hospital stay for patients.
Background:
The premise for adopting minimally invasive cardiac surgery techniques for myocardial revascularization is to reduce the patient's morbidity without compromising the efficacy of conventional coronary artery bypass. However, opening the pleura has been a limitation of using these approaches.
Aim:
We used the xiphoid approach as an alternative to opening the pleura and to minimize pain after minimally invasive coronary artery bypass surgery.
Methods:
We review our surgical experience in 55 patients who underwent minimally invasive direct coronary artery bypass (MIDCAB) surgery through a xiphoid approach between October 1997 and August 1999. Thoracoscopy (n = 31) or direct vision (n = 24) were used for internal mammary artery (IMA) harvesting. Mean patient age was 67 +/- 10 years and 65% were men. The mean Parsonnet score was 23 +/- 10. Performed anastomoses included left IMA (LIMA) to the left anterior descending (LAD) artery (n = 53), LIMA-to-LAD and saphenous vein graft from the LIMA to the right coronary artery (n = 1), and LIMA-to-LAD and right IMA (RIMA) to right coronary artery (n = 1).
Results:
Postoperative complications included atrial fibrillation (12%), acute noninfectious pericarditis (12%), and acute renal failure (5%). Mean postoperative length of stay was 4 +/- 2 days. Angiography was performed in 16 patients and demonstrated excellent patency of the anastomoses. There was no operative mortality. Actuarial survival was 98% in a mean follow-up period of 11 +/- 5 months.
Conclusions:
Minimally invasive coronary artery bypass can be performed safely through a xiphoid approach with low morbidity, mortality, and a relatively short hospital stay.
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