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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
How safe is the port access technique in minimally invasive coronary artery bypass grafting?
Selami Dogan1, Kai Graubitz, Tayfun Aybek
1Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Frankfurt, Germany. s.dogan@em.uni-frankfurt.de
Insights
Minimally invasive multivessel coronary artery bypass grafting (CABG) is safe and feasible. While it showed higher S-100B protein levels, it provided equivalent myocardial and cerebral protection compared to conventional CABG.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Cardiac Surgery Outcomes
Background:
- Comparing conventional coronary artery bypass grafting (CABG) with port access CABG.
- Evaluating clinical, neuropsychological, and angiographic outcomes.
- Assessing myocardial and cerebral protection, and inflammatory response to cardiopulmonary bypass (CPB).
Purpose of the Study:
- To compare the safety and efficacy of conventional CABG versus port access CABG for multivessel revascularization.
- To evaluate clinical, neurological, and cardiac outcomes between the two surgical approaches.
- To analyze markers of myocardial, cerebral, and systemic inflammatory response.
Main Methods:
- Prospective randomized study of 40 patients undergoing multivessel CABG.
- Group A: Conventional CABG via median sternotomy. Group B: Port access CABG via minithoracotomy.
- Neuropsychological testing, cardiac enzyme analysis (CK, CK-MB, Troponin T), cerebral injury markers (S-100B, NSE), and inflammatory markers (C5b-9, myeloperoxidase) were measured.
Main Results:
- No mortality observed in either group.
- Similar levels of Troponin T, CK-MB, NSE, and neuropsychological test results.
- Higher CK and myoglobin in the minimally invasive group; higher S-100B in the port access group.
- Comparable inflammatory response markers (C5b-9, myeloperoxidase) and myocardial protection.
Conclusions:
- Port access CABG is a feasible and safe minimally invasive option for multivessel revascularization.
- Despite longer CPB times and elevated S-100B in the port access group, myocardial and cerebral protection were equivalent.
- The study supports the use of minimally invasive techniques for complex cardiac procedures.
Background:
This study compares conventional coronary artery bypass grafting (CABG) with port access CABG via a left anterior small thoracotomy in patients requiring surgical multivessel revascularization. Clinical, neuropsychological, and angiographic outcomes were studied, as well as parameters of myocardial and cerebral protection. Pathogenicity of cardiopulmonary bypass (CPB) was further evaluated by measuring parameters of peripheral limb ischemia and inflammatory whole-body response.
Methods:
In a prospective randomized study, 40 patients who required multivessel CABG were assigned to either conventional CABG via complete median sternotomy (group A) or port access CABG via minithoracotomy (group B). Control angiograms were performed in group B only. In addition, patients underwent neuropsychological testing after the operation. CK, CK-MB, and Troponin T levels were documented. S-100B protein and neuron-specific enolase (NSE) served to quantify cerebral injury. The terminal complement complex (C5b-9) and myeloperoxidase concentrations were determined to analyze inflammatory whole-body response after CPB.
Results:
There was no mortality. One patient suffered a retrograde aortic dissection immediately after onset of CPB, but had an uneventful postoperative course after surgical repair. Troponin T and CK-MB showed no difference between groups. CK and myoglobin were significantly higher in the minimally invasive cohort. Changes in complement activation (C5b-9) and myeloperoxidase during CPB markers of the whole-body inflammatory response were similar in both groups. S-100B concentrations in the port access group were significantly higher, whereas NSE levels were similar in both groups. Both groups did not display any significant difference in neuropsychological testing.
Conclusions:
Minimally invasive multivessel CABG via minithoracotomy using port access technology is feasible and safe. Though prolonged operating and CPB times with significantly higher S-100B concentrations were observed in group B, equivalent myocardial and cerebral protection and similar whole-body inflammatory response were documented.
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