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Reoperative coronary bypass grafting without cardiopulmonary bypass through a small thoracotomy
P W Boonstra1, J G Grandjean, M A Mariani
1Thoraxcenter, University Hospital of Groningen, The Netherlands.
Insights
Minimally invasive direct coronary artery bypass is a safe and promising option for reoperative coronary surgery, particularly when only the left anterior descending artery requires bypass and the left internal mammary artery is available.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary reoperations carry risks associated with sternal reopening and cardiac manipulation.
- Minimally invasive direct coronary artery bypass (MIDCAB) offers a potential solution for selected reoperative cases.
Purpose of the Study:
- To evaluate the safety and efficacy of MIDCAB for coronary reoperations.
- To assess the feasibility of using the left internal mammary artery (LIMA) for revascularization of the left anterior descending (LAD) coronary artery in reoperative patients.
Main Methods:
- Eighty-one MIDCAB procedures were performed between January 1995 and May 1996.
- Six of these patients underwent reoperative MIDCAB, having previously had coronary artery bypass grafting (CABG) via median sternotomy.
- The LIMA was anastomosed to the LAD through a small anterolateral thoracotomy.
Main Results:
- The mean operative time was 85.8 minutes.
- The mean postoperative hospital stay was 5.7 days.
- No mortality or cardiac-related morbidity was observed in the reoperative MIDCAB group.
Conclusions:
- MIDCAB is a safe and promising technique for selected reoperative coronary artery bypass grafting.
- This approach minimizes the risks associated with traditional sternotomy in reoperative cardiac surgery.
Background:
The danger of coronary reoperations is mainly hidden in the reopening of the sternum and in the manipulation of the heart and the old grafts. Therefore, the minimally invasive direct coronary artery bypass procedure seems an ideal technique for coronary reoperations if only the left anterior descending coronary artery needs to be revascularized and the left internal mammary artery has not been used previously.
Method:
From January 1995 until May 1996 we performed 81 minimally invasive direct coronary artery bypass procedures through a small anterolateral thoracotomy in the fifth intercostal space, anastomosing the left internal mammary artery to the left anterior descending coronary artery. Six of these 81 were reoperative minimally invasive direct coronary artery bypass procedures on patients who had previously undergone coronary grafting through a median sternotomy with a vein graft to the left anterior descending coronary artery.
Results:
Mean operation time was 85.8 +/- 22.2 minutes. Mean length of the mammary pedicles was 13 +/- 2 cm. Mean coronary occlusion time was 9.2 +/- 3.2 minutes. Mean postoperative hospital stay was 5.7 +/- 1.2 days (range, 5 to 8 days). No mortality and no cardiac-related morbidity were recorded.
Conclusions:
These results suggest that the technique is safe and promising in selected cases of reoperative coronary operation.