Redo Minimally Invasive Off-pump Coronary Artery Bypass Surgery In Off-pump Era
Seoul Veterans Hospital, Seoul, Korea, Republic of.
Backgrounds: Redo CABG is still remained as a major concern to cardiac surgeons due to high mortality and morbidity. Off-pump technique and minimally invasive approach thru avoiding redo-sternotomy are a safe combination modality to treat repeated coronary artery atherosclerosis. Therefore, we evaluate the feasibility of redo minimally invasive OPCAB thru avoiding redo-sternotomy and its results.
Methods: From April 1998 to October 2017, 639 patients underwent CABG. Among them, we conducted OPCAB in 189 patients (30%) and redo CABG in 27 cases (4%). There was no on-pump redo CABG and minimally invasive approach is 22 cases. These 22 patients are the subjects of this study. Median age is 70 years old (range: 58-83) and all of them are male. Coronary access routes were Lt anterior small thoracotomy in 10, inverted U laparotomy in 8 and para-sternal vertical thoracotomy in 4. Time interval between 1st and redo is 10.4 years (range: 0.3-20.8 years). The timing of redo is early failure in 2 at 3.1 months and 7.5 months, midterm failure in 2 at 2.7 years and 3.2 years, and delayed failure in 18 at median 10.8 years (range: 6.6-20.8 years). The reason of redo is newly-developed coronary lesion in 9 (41%) and previous graft failure in 16 (73%). Failed grafts were LIMA-to-LAD in 5, non-LAD arterial graft in 5 and non-LAD vein graft in 6.
Results: Median op time is 243 minutes (155-450), and there was no on-pump conversion during OPCAB surgery but intraoperative IABP support in 3 cases (14%). Postop ICU-stay and hospital-stay are 2 days (1-10) and 14 days (8-38), respectively. There was an operative mortality (4%) due to ARDS and enteritis, but four morbidities (18%: pneumonia, pleural effusion, leg wound problem, ARDS, enteritis). Overall and MACE-free survival times are 1004 and 1062 days, respectively and 3-year survival rates are 76% and 81%, respectively.
Conclusions: Conducting redo MICS off-pump CABG surgery is feasible and its results are acceptable.
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