Related Experiment Videos
Minimally invasive LAD revascularisation in high-risk patients with three-vessel coronary artery disease
1Department of Surgery, The Chinese University of Hong Kong. izzat@mailserv.cuhk.edu.hk
Insights
Minimally invasive direct coronary artery bypass (MIDCAB) offers an effective surgical revascularization option for high-risk patients with three-vessel coronary artery disease. This approach demonstrated good graft patency and symptom relief in a small patient cohort.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Conventional coronary artery bypass surgery poses increased risks for patients with comorbidities or contraindications to cardiopulmonary bypass.
- Minimally invasive direct coronary artery bypass (MIDCAB) presents a potential alternative for surgical revascularization in select patient populations.
Purpose of the Study:
- To evaluate the early outcomes and feasibility of adopting the MIDCAB approach for patients with three-vessel coronary artery disease.
- To assess the efficacy of MIDCAB in high-risk patients who are not candidates for traditional bypass surgery.
Main Methods:
- A review of 13 patients (mean age 67.6 years) with severe symptomatic three-vessel coronary artery disease treated with MIDCAB.
- Left internal mammary artery grafts were used to revascularize the left anterior descending coronary artery.
- Patients had significant comorbidities including renal failure, arteriopathy, COPD, poor general condition, and impaired left ventricular function.
Main Results:
- One early postoperative mortality; no other cardiac morbidity.
- Rapid recovery with early extubation (mean 3 hours), short intensive care unit (ITU) stay (mean 15 hours), and hospital stay (mean 5 days).
- High graft patency rate (11 out of 13 grafts patent) and complete angina-free status at 3-11 months follow-up when combined with medical therapy.
Conclusions:
- MIDCAB is an effective surgical revascularization strategy for high-risk patients with symptomatic three-vessel coronary artery disease.
- Further long-term follow-up is necessary to refine patient selection criteria and confirm sustained outcomes.
Objective:
A potential advantage of minimally invasive direct coronary artery bypass (MIDCAB) is that patients in whom conventional coronary bypass surgery is associated with increased risk because of various associated medical conditions, or those with relative contraindications to cardiopulmonary bypass, can benefit from surgical revascularisation. We reviewed our experience with adopting MIDCAB in the management of patients with three-vessel coronary artery disease over an 8 month period.
Methods:
Thirteen patients (3 females, mean age 67.6 years) with severe symptomatic three vessel coronary artery disease on maximum medical treatment (angina class III or IV) received left internal mammary artery grafts to the left anterior descending coronary artery using the MIDCAB approach. Associated co-morbidity included: severe chronic renal failure (n=2), severe extensive arteriopathy (n=4), chronic obstructive airway disease (n=2), poor general condition (n=2) and severely impaired left ventricular function (n=3).
Results:
There was one early postoperative mortality and no other cardiac related morbidity. All patients were extubated within 3 h of leaving the operating room, mean ITU stay was 15 h and mean hospital stay was 5 days. Graft patency was investigated using angiography in all patients; all grafts but two were patent. In combination with medical therapy, all patients remain entirely angina free at a follow-up period between 3-11 months.
Conclusions:
MIDCAB is an effective approach for managing high-risk patients with symptomatic three-vessel coronary artery disease. Longer follow-up is needed to further clarify patient selection and the long-term outcome of this approach.