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Coronary bypass grafting via minithoracotomy on the beating heart
1Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey. oisik@ibm.net
Insights
Minimally invasive coronary artery bypass grafting using minithoracotomy and beating heart techniques offers a safe and effective alternative. This approach reduces operative trauma, cost, and improves patient comfort with good clinical outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is evolving towards less invasive techniques.
- Minimally invasive CABG offers benefits in patient comfort and reduced hospital stay.
Purpose of the Study:
- To evaluate the clinical results of coronary artery bypass grafting performed via minithoracotomy on a beating heart.
- To assess the feasibility and safety of harvesting the left internal thoracic artery using videothoracoscopic assistance.
Main Methods:
- 40 patients underwent CABG using minithoracotomy incision without cardiopulmonary bypass.
- Left internal thoracic artery was harvested primarily via video-assisted thoracoscopy.
- Procedures were performed on the beating heart, with two cases converted to conventional technique.
Main Results:
- Left internal thoracic artery harvesting was completed via video-assisted thoracoscopy in 11 patients and partially in 24.
- 38 patients received bypass grafts to the left anterior descending coronary artery.
- No mortality was observed; one patient experienced perioperative myocardial infarction and one lung injury.
Conclusions:
- Coronary artery bypass grafting via minithoracotomy is effective and safe.
- This technique reduces operative trauma, cost, and enhances patient comfort.
- The procedure demonstrates a favorable risk-benefit profile for selected patients.
Background:
Recently the availability and the superiority of less invasive coronary artery bypass grafting on some selected groups of patients in the meaning of patient comfort and short hospital stay has been shown by some authors. We present here the clinical results of 40 patients operated on by minithoracotomy incision on the beating heart without using cardiopulmonary bypass mostly harvesting the left internal thoracic artery by videothoracoscopic assistance.
Methods:
Between March 1996 and September 1996, 40 patients were operated on by harvesting the left internal thoracic artery mostly by video-assisted thoracoscopy and performing bypass through a minitoracotomy incision. Two patients in whom the procedure was switched to conventional technique were not included in this series. Nine of the patients were female and the rest were male. The mean age was 43.2 +/- 7.
Results:
Left internal thoracic arteries were harvested by video-assisted thoracoscopy completely in 11 patients, incompletely in 24 patients (the harvesting was completed by direct vision afterwards), and under direct vision in 5 through a mini-anterior thoracotomy incision. Thirty-six patients received a bypass graft to left anterior descending coronary artery only, whereas 4 received a diagonal branch graft also. Left internal thoracic arteries were used to bypass the left anterior descending coronary artery directly in 38 patients. The left internal thoracic artery was injured in the middle portion during harvesting in 1 of the remaining 2 patients. The length was not enough in the other. A short saphenous vein graft was interposed between the left internal thoracic artery and the left anterior descending coronary artery in these 2 patients. There was no mortality. One patient had perioperative myocardial infarction. We did not see serious morbidity except one lung injury due to the trochar.
Conclusions:
The results obtained from our experience suggest that coronary artery bypass grafting by minithoracotomy could be applied effectively and safely without overwhelming additional risk to the patient. Furthermore, it has some advantages in reducing operative trauma and cost and also improving patient comfort.