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Multivessel Arterial Revascularization via Left Anterior Thoracotomy
Oleksandr Babliak1, Volodymyr Demianenko1, Yevhenii Melnyk1
1Cardiac Surgery Center, Medical Network Dobrobut, Kyiv, Ukraine.
Seminars in Thoracic and Cardiovascular Surgery
|March 2, 2020
Summary
Minimally invasive multivessel coronary artery bypass grafting via left anterior thoracotomy is a safe and effective technique. Multivessel revascularization using multiple arterial grafts can be performed with excellent outcomes, though it may increase operation time.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Coronary Artery Disease
Background:
- Minimally invasive coronary revascularization offers potential benefits over traditional sternotomy.
- Multivessel coronary artery disease (CAD) requires complete revascularization for optimal outcomes.
Purpose of the Study:
- To present the technique of multivessel minimally invasive coronary revascularization (MICR) through left anterior thoracotomy.
- To evaluate the perioperative outcomes of MICR, comparing uniarterial and multiarterial graft strategies.
Main Methods:
- A total of 229 patients with isolated multivessel CAD underwent complete coronary revascularization via left anterior minithoracotomy (6-8 cm incision).
- Cardiopulmonary bypass (CPB), Chitwood clamp, and blood cardioplegia were utilized in all procedures.
- Multiarterial revascularization was performed in 47 patients using the left internal mammary artery (LIMA) and T-shunt with the left radial artery or right internal mammary artery (RIMA).
Main Results:
- No mortality, perioperative myocardial infarcts, or conversion to sternotomy were observed in either group.
- Mean distal anastomoses, CPB time, and total hospital stay were comparable between uniarterial and multiarterial graft groups.
- Aortic cross-clamp time and total operation time were significantly longer in the multiarterial revascularization group.
Conclusions:
- Multivessel coronary bypass grafting can be routinely performed minimally invasively through left anterior thoracotomy using CPB and cardioplegia.
- Multiarterial revascularization in selected patients via this approach yields excellent procedural outcomes.
- The technique is safe and effective for complete revascularization in patients with multivessel coronary artery disease.
Keywords:
CABGCoronary artery bypassMinimally invasive coronary artery bypass graftingT-shuntTCRAT, Total coronary revascularization via left anterior thoracotomyTotal arterial revascularization
