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Published on: September 15, 2023
Our experiences for off-pump coronary artery bypass grafting to the circumflex system
Tomoaki Suzuki1, Manabu Okabe, Fuyuhiko Yasuda
1Kochi Municipal Hospital, Kochi, Japan. suzukit@bronze.ocn.ne.jp
Insights
New techniques and instruments enable complete revascularization during off-pump coronary artery bypass grafting (OPCAB) surgery, even in the challenging circumflex territory. This approach ensures hemodynamic stability and excellent early outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Procedures
- Interventional Cardiology
Background:
- Complete revascularization is challenging in off-pump coronary artery bypass grafting (OPCAB).
- Hemodynamic instability often limits access to the circumflex artery territory during OPCAB.
- Novel instrumentation and techniques are needed to overcome these limitations.
Purpose of the Study:
- To present specialized instrumentation and techniques for accessing the circumflex territory during OPCAB.
- To evaluate the clinical experience and outcomes of using these methods in patients undergoing OPCAB.
Main Methods:
- A series of techniques and instruments were developed, including left pericardial traction and right pericardial compression.
- A right sternal retractor and specialized shunt tubes were utilized to maintain access and stability.
- 114 patients requiring circumflex artery reconstruction during OPCAB via sternotomy were included.
Main Results:
- Complete revascularization was achieved in 95% of patients.
- The average number of grafts per patient was 3.2.
- Low complication rates were observed, including 0.8% respiratory insufficiency and 0.8% sternal wound infection. No perioperative myocardial infarction, stroke, or operative death occurred. Predischarge angiography showed a 99% graft patency rate.
Conclusions:
- The developed techniques and instruments facilitate safe and complete revascularization of the circumflex area during OPCAB.
- Excellent early clinical results suggest the effectiveness of this approach.
- Long-term follow-up is necessary to confirm the sustained efficacy of these OPCAB techniques.
Background:
Complete revascularization has been difficult in off-pump coronary artery bypass grafting (OPCAB). Hemodynamic deterioration often prevents access to the circumflex territory. This study presents instrumentation for accessing the circumflex territory, and our clinical experience.
Methods:
From August 1999 through December 2002, 140 patients underwent OPCAB via sternotomy in our institution. The 114 requiring reconstruction of the circumflex artery are the subjects of this study. There were no exclusion criteria. A series of techniques and instruments were developed to provide access to the circumflex area while hemodynamic stability was preserved, including the left pericardial traction technique, compression of the right pericardium, a right sternal retractor, and a type of shunt tube.
Results:
Patients received an average of 3.2 grafts (range, 2 to 6). Complete revascularization was achieved in 95% of the cases. Complications included respiratory insufficiency (0.8%), renal dysfunction (7%), and sternal wound infection (0.8%). Blood transfusions were required in 10 patients (8%). No patient suffered perioperative myocardial infarction or stroke. No operation was converted to cardiopulmonary bypass. There was no operative death. Predischarge angiography demonstrated a 99% patency rate.
Conclusions:
With our techniques and instruments, off-pump coronary revascularizaion of the circumflex area may be performed safely to achieve complete revascularization. Early clinical results are excellent, but long-term longitudinal follow-up is required to assess the future effectiveness of OPCAB procedure with our techniques.
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