Results Of Minimal Invasive Total Arterial Multivessel Midcab
CHIRAG DOSHI, MANISH K. HINDUJA.
UNMICRC, AHMEDABAD, India.
OBJECTIVE: In current era of cardiac surgery, minimal invasive coronary artery bypass (MIDCAB)plays an important and challenging role. Also MIDCAB with bilateral internal thoracicconduits or total arterial grafts is the best option for patients with coronary arterydisease who are high risk for sternotomy. We evaluated 108 such selected patients who underwent minimally invasive multivessel total arterial off pump anaortic CABG through left anterolateral thoracotomy.
METHODS: The procedure was performed using 4-8 cm left anterolateral thoracotomy incision.LIMA harvested in every patient, RIMA or radial artery used as second conduit. LIMA RIMA Y, or LIMA -RADIAL Y was made to accomplish multivessel total arterial bypassgrafting. All intraoperative (hemodynamics and requirement of inotropic support,perioperative blood transfusion ) and post-operative data (bleeding, wound infection,pain score, ICU stay, duration of mechanical ventilation, arrhythmias, perioperative MI,pleural effusion, need for IABP support, and post operative patient satisfaction index)were collected and evaluated. Post-operative graft patency was checked in everypatient by CT coronary angiography 6 months following discharge.
RESULTS: Multivessel total arterial CABG was accomplished in all selected individuals. There wasno mortality or wound infection. Re-exploration was done in one patient for bleeding. Intwo patients saphenous vein was used to graft LAD and LIMA used to graft diagonal as LIMA length was not adequate to graft distal LAD. In one individual conversion tosternotomy and CPB was required due to unstable hemodynamics. Muscle healing of anterolateral thoracotomy was faster as compared to bone healing of conventional sternotomy incision. LIMA to LAD was patent angiographically in all postoperative patients.
CONCLUSIONS: With conventional immobilization techniques and instruments multivessel, total arterialMIDCAB can be accomplished safely in selected individuals. RIMA can be harvested inlong standing diabetic patients with no concern for sternal wound healing. Musclehealing of anterolateral thoracotomy is faster as compared to bone healing ofconventional sternotomy and patients are back to normal life earlier.
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