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Published on: March 27, 2018
Coronary Artery Bypass Grafting using Bilateral Internal Thoracic Arteries through a Left-Sided Minithoracotomy: A
Mahmoud Diab1, Gloria Färber1, Christoph Sponholz2
1Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.
Insights
Minimally invasive coronary artery bypass grafting (MICS-CABG) using bilateral internal thoracic artery (BITA) offers excellent long-term survival with reduced sternal wound infection risk. This approach demonstrates safe and effective myocardial revascularization with good short-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Thoracic Surgery
Background:
- Bilateral internal thoracic artery (BITA) grafting offers superior long-term survival in coronary artery bypass grafting (CABG).
- Conventional sternotomy for BITA use increases sternal wound infection risk.
- Minimally invasive coronary artery bypass grafting (MICS-CABG) presents an alternative to mitigate these risks.
Purpose of the Study:
- To evaluate the initial outcomes of MICS-CABG utilizing BITA.
- To assess the safety and efficacy of this minimally invasive approach for myocardial revascularization.
Main Methods:
- Patients underwent MICS-CABG via a left-sided minithoracotomy, exclusively off-pump.
- Quality of life was assessed using the SF-36 questionnaire.
- Surgical procedures were performed between February 2016 and August 2017.
Main Results:
- Twenty-one MICS-CABG procedures using BITA were completed without intraoperative complications or conversion to sternotomy/on-pump.
- Postoperative outcomes included two re-explorations for bleeding and two early graft failures.
- No strokes or in-hospital mortality occurred; angina relief was universal, and 20 patients reported good quality of life at a median 13-month follow-up.
Conclusions:
- Off-pump myocardial revascularization with BITA is safely achievable through a left-sided minithoracotomy.
- MICS-CABG using BITA demonstrates favorable short-term results and good patient quality of life.
- This technique offers a promising alternative for patients requiring BITA grafting.
Background:
Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) is associated with the best long-term survival. However, using BITA increases the risk of sternal wound infections with conventional sternotomy. We describe here our initial results of minimally invasive CABG (MICS-CABG) using BITA.
Methods:
Patients were operated through an incision similar to that of standard minimally invasive direct CABG. All operations were performed off-pump. We evaluated patient's quality of life (QoL) using the Medical Outcomes trust, 36-Item Short Form Health Survey (SF-36).
Results:
Between February 2016 and August 2017, we performed 21 cases of MICS-CABG using BITA. There was no intraoperative complication and no conversion to sternotomy or to on-pump. Two patients required reexploration through the same minithoracotomy for postoperative bleeding. Two cases of early postoperative graft failure were identified. There was no stroke or in-hospital mortality. The median duration of follow-up was 13 months, with a maximum of 19 months. Relief of angina was achieved in all patients. There was one readmission for superficial wound infection, which was conservatively treated. An 84-year-old man died 4 months after the operation. The remaining 20 patients attested good QoL with the SF-36 questionnaire.
Conclusions:
Myocardial revascularization using BITA can be safely achieved off-pump through a left-sided minithoracotomy with good postoperative and short-term outcomes.
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