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Published on: November 24, 2014
Minimally invasive approach for coronary artery fistula correction
Laichun Song1, Bo Wang1, Jing Jin1
1Department of Cardiac Surgery, Asia Heart Hospital, Wuhan, China.
Insights
Minimally invasive coronary artery fistula (CAF) correction without cardiopulmonary bypass is feasible and safe. This approach offers excellent exposure and a cosmetic alternative to conventional methods, potentially reducing hospital stays.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Congenital Heart Disease
Background:
- Coronary artery fistulas (CAFs) are abnormal connections between a coronary artery and a cardiac chamber or great vessel.
- Minimally invasive cardiac surgery (MICS) is increasingly adopted for various cardiac procedures.
- The feasibility of MICS for CAF correction requires further investigation.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a minimally invasive approach for coronary artery fistula (CAF) correction.
- To assess the safety, efficacy, and potential benefits of MICS for CAF repair compared to traditional methods.
Main Methods:
- A retrospective analysis of 49 patients who underwent minimally invasive CAF correction without cardiopulmonary bypass (CPB) between February 2001 and June 2014.
- Exclusion criteria included patients with cardiac anomalies and those requiring CPB for MICS CAF correction.
- Surgical approaches included subxiphoid and parasternal incisions.
Main Results:
- No in-hospital mortalities or conversions to median sternotomy were reported.
- The mean operative time was 67.45 ± 22.69 minutes, with a mean intubation time of 3.72 ± 1.82 hours.
- A single patient had a trivial residual shunt, which resolved by discharge; intensive care unit (ICU) stay averaged 9.67 ± 5.43 hours.
Conclusions:
- Minimally invasive CAF correction without CPB provides excellent surgical exposure for select patients.
- This approach is a safe and cosmetic alternative to conventional surgery.
- MICS for CAF repair may lead to a minimized length of hospital stay.
Objectives:
Minimally invasive cardiac surgery has recently become widespread. The aim of this study is to analyse the feasibility of a minimally invasive approach for coronary artery fistula (CAF) correction.
Methods:
From February 2001 to June 2014, 49 patients in our centre underwent minimally invasive CAF correction without cardiopulmonary bypass (CPB). The mean age was 21.18 ± 11.24 years (range, 5 months to 64 years). Patients with cardiac anomalies who underwent CAF correction and those who underwent CAF via the minimally invasive approach with CPB were excluded.
Results:
There were no in-hospital mortalities or conversions to median sternotomy. Subxiphoid incisions (22 cases) and parasternal incisions (20 cases) were the most commonly used approaches for the procedure. The operative time was 67.45 ± 22.69 min (30-125 min). The intubation time was 3.72 ± 1.82 h (2-12 h), and the ICU stay was 9.67 ± 5.43 h (4-24 h). A trivial residual shunt was identified in only 1 patient during the procedure; however, this shunt had disappeared by discharge.
Conclusions:
The minimally invasive approach can provide excellent surgical exposure for CAF ligation in select patients. This approach is a safe and cosmetic alternative to conventional treatment and may minimize the length of stay.
