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Minimal access surgical techniques in coronary artery bypass grafting for triple-vessel disease
1Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.
Insights
Minimal access surgery for coronary artery bypass grafting is feasible for triple-vessel disease. This approach offers a potential alternative for surgical revascularization with promising early outcomes.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Coronary Artery Disease
Background:
- Minimal access surgical techniques are primarily used for single-vessel coronary artery disease.
- The application of these techniques to more complex coronary artery disease, such as triple-vessel disease, remains less established.
Purpose of the Study:
- To evaluate the technical feasibility and early outcomes of minimal access coronary artery bypass grafting for triple-vessel disease.
Main Methods:
- Fifteen patients with triple-vessel disease underwent coronary artery bypass grafting using minimal access techniques.
- Procedures involved a limited left parasternal thoracotomy and femorofemoral extracorporeal circulation.
- Myocardial protection was achieved with antegrade cold blood cardioplegia during aortic cross-clamping.
Main Results:
- All patients received sequential left saphenous vein grafts and a left internal thoracic artery graft.
- Mean aortic cross-clamp time was 86 minutes, and mean extracorporeal circulation time was 112 minutes.
- Postoperative recovery was uneventful, with no late deaths or angina at a mean follow-up of 7.4 months. Coronary angiography showed patent grafts in 8 patients.
Conclusions:
- Minimal access coronary artery bypass grafting is technically feasible for triple-vessel disease.
- This approach represents a viable alternative for surgical revascularization in selected patients with complex coronary artery disease.
Background:
Minimal access surgical techniques in coronary artery bypass grafting have been used mainly in the management of single-vessel disease.
Methods:
Fifteen patients, 11 men and 4 women with a mean age of 64.1 years (range, 35.7 to 78.0 years), underwent operation for triple-vessel disease using minimal access techniques. The procedures were performed through a limited left parasternal thoracotomy using femorofemoral extracorporeal circulation. The myocardium was protected by the antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped.
Results:
Under direct vision, the left saphenous vein grafts were connected sequentially to the diagonal branch, obtuse marginal branch, and posterior descending branch, and the left internal thoracic artery graft was anastomosed to the left anterior descending artery in each patient. The mean aortic cross-clamp time was 86 +/- 17 minutes (range, 67 to 125 minutes). The mean duration of extracorporeal circulation was 112 +/- 22 minutes (range, 82 to 162 minutes). The postoperative course was uneventful in all patients. Follow-up was complete in all patients at a mean of 7.4 months (range, 6.0 to 8.5 months), and there were no late deaths or angina. Coronary angiography in 8 patients showed patent grafts.
Conclusions:
Our experience demonstrates that minimal access surgical techniques in coronary artery bypass grafting are technically feasible and may be an alternative approach in the surgical revascularization of triple-vessel disease.