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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
Segmental myocardial wall motion during minimally invasive coronary artery bypass grafting using open and endoscopic
S Mierdl1, C Byhahn, V Lischke
1*Department of Anesthesiology, Intensive Care Medicine and Pain Control, †Department of Thoracic and Cardiovascular Surgery, J.W. Goethe-University Hospital, Frankfurt, Germany.
Insights
Minimally invasive coronary artery bypass grafting (CABG) techniques, including MIDCAB and TECAB, cause temporary heart wall motion abnormalities. TECAB procedures showed more pronounced abnormalities, potentially due to CO2 insufflation, but all resolved post-revascularization.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Echocardiography
Background:
- Current minimally invasive options for single-vessel coronary artery disease include mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB).
- Both procedures carry risks of myocardial stress, including single-lung ventilation, coronary occlusion, and prolonged cardiopulmonary bypass (CPB) time.
Purpose of the Study:
- To evaluate intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB procedures.
- To identify factors influencing SWMA in these minimally invasive cardiac surgery techniques.
Main Methods:
- A comparative echocardiographic study of 46 patients with single-vessel coronary artery disease (16 MIDCAB, 30 TECAB).
- Sequential transesophageal echocardiograms were recorded throughout surgery, with simultaneous hemodynamic and oxygenation monitoring.
Main Results:
- Mild but evident perioperative SWMA were observed in both MIDCAB and TECAB groups, increasing during surgery.
- SWMA were more pronounced in the TECAB group, possibly linked to intrathoracic CO2 insufflation.
- All SWMA resolved completely after revascularization, with no significant hemodynamic compromise or persistent abnormalities.
Conclusions:
- Both MIDCAB and TECAB techniques are associated with significant perioperative SWMA.
- TECAB may present a higher risk of right ventricular dysfunction due to more extensive SWMA.
- These findings highlight the importance of monitoring myocardial function during minimally invasive CABG.
Abstract:
Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass (CPB) via mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB) with CPB. Both procedures are associated with potential myocardial stress before revascularization, such as single-lung ventilation (SLV), temporary coronary artery occlusion, cardiac luxation, intrathoracic carbon dioxide insufflation, and extended CPB and operating time. In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB surgery and to identify factors affecting SWMA. Forty-six patients with single-vessel coronary artery disease were studied. Sixteen patients were operated using the MIDCAB technique and 30 patients with TECAB. In both groups sequential transesophageal echocardiograms were recorded during the entire procedure. Hemodynamic data and oxygenation variables were acquired simultaneously. In both groups, mild but obvious perioperative SWMA were identified and noted to increase during the course of the operation. These SWMA were more pronounced in the TECAB group. Independent of operating time, these changes disappeared completely after revascularization. No significant hemodynamic compromise was observed. We conclude that MIDCAB and TECAB techniques are associated with significant perioperative SWMA. The appearance of more profound SWMA in the TECAB group compared with the MIDCAB patients might have been the result of intrathoracic CO(2) insufflation, as SLV was used in both groups. No persistent SWMA or post-CPB SWMA were apparent in either group. More extensive intraoperative ventricular SWMA was detected in the TECAB group, suggesting that a more frequent risk for right ventricular dysfunction may exist during TECAB procedures.
