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Minimally invasive surgical treatment of coronary artery multivessel disease
V Gulielmos1, M Knaut, R Cichon
1Cardiovascular Institute, University Hospital Dresden, Germany.
Insights
Minimally invasive coronary artery bypass grafting avoids median sternotomy or cardiopulmonary bypass. Both beating heart and sternotomy techniques are safe alternatives for multivessel coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery multivessel disease treatment often involves median sternotomy or cardiopulmonary bypass.
- Minimally invasive procedures aim to avoid these conventional methods.
Purpose of the Study:
- To evaluate an alternative technique for coronary artery disease treatment.
- To assess the safety and efficacy of beating heart procedures compared to sternotomy.
Main Methods:
- 102 patients with single- to multivessel coronary artery disease were treated between November 1996 and January 1998.
- An alternate technique, including a beating heart procedure with the Octopus stabilizer, was used.
- A high-risk subgroup received median sternotomy with a beating heart procedure.
Main Results:
- No intraoperative deaths occurred in either group.
- Two postoperative deaths due to pneumonia were observed in the beating heart (Octopus) group.
Conclusions:
- Both evaluated techniques offer safe alternatives to conventional coronary artery bypass grafting.
- These methods are suitable for patients with coronary artery multivessel disease.
Background:
If coronary artery multivessel disease is the target of a minimally invasive procedure, either median sternotomy or cardiopulmonary bypass can be avoided.
Methods:
We used an alternate technique instead of minithoracotomy and cardiopulmonary bypass to treat 102 patients (82 men, 20 women; age range, 39 to 82 years; median, 61.0 +/- 8.9 years) for coronary artery single-vessel, double-vessel, or multivessel disease between November 1996 and January 1998. Twenty-nine patients (22 men, 7 women; age range, 46 to 78 years; median, 69.0 +/- 8.4 years), who were in a high-risk group for the development of perioperative complications because of the use of cardiopulmonary bypass, received median sternotomy and a beating heart procedure using the Octopus stabilizing technique. The left anterior descending coronary artery was the target vessel in all patients except for 1, in whom the left internal mammary artery was used.
Results:
There was no intraoperative death in either series. In the beating heart group (Octopus) 2 patients died on postoperative day 31 and 35, respectively, of postoperative pneumonia.
Conclusions:
Both techniques present safe alternative procedures to conventional coronary artery bypass grafting in patients with coronary artery multivessel disease.