Resurgence In Endocab -the King’S Experience
Amir Sepehripour, Muhammad Anjum, Julia Glizevskaja, Max Baghai, Ranjit Deshpande.
King's College Hospital, London, United Kingdom.
Background Analysis of our experience and results in endoscopically-assisted minimally invasive coronary artery bypass surgery (CABG). Methods We retrospectively analysed our records, from February 2010 till December 2017. Using electronic case notes and local PATS database we extracted data including pre-operative demographics, EuroSCORE, and post-operative major adverse cardiovascular and cerebrovascular events. Results We performed 84 cases (73 male), mean age was 72.4± 3.6, mean logistic EuroSCORE was 4.2± 1.6, 18 (21%) were performed as part of a staged revascularization strategy with percutaneous coronary intervention (PCI) to significant non-left anterior descending (LAD) lesions. There was a progressive increase in the number of cases performed, 3 in 2010 increasing to 21 thus far in 2017. The operation was performed in two stages. Firstly, totally endoscopic left internal mammary artery (LIMA) harvest with a 3-port approach using an ultrasonic scalpel. Secondly, off-pump coronary anastomosis of LIMA to LAD (+/- diagonal sequential graft) through a 4cm left anterior thoracotomy. Five (5.9%) patients underwent sequential LIMA to diagonal to LAD grafting. There were no incidences of mortality, stroke, peri-operative myocardial infarction or any other major adverse cardiovascular or cerebrovascular events. There were 2 (2.4%) intra-operative conversions to sternotomy. One for the finding of an intra-myocardial LAD, and the second for a lack of adequate flow in the LIMA, which necessitated a sternotomy and harvest of the right internal mammary artery (RIMA) for LAD grafting. There was 1 (1.2%) incident of repeat revascularization with PCI to the native LAD disease. There were 2 (2.4%) incidences of superficial wound infection. The average length of stay was 5.1± 1.5 days. Conclusions Our results demonstrate the resurgence, progressive increase and excellent outcomes with endoscopically-assisted minimally invasive CABG. The complete harvest and division of all branches of the LIMA endoscopically results in less recurrent angina and allows the use of a smaller thoracotomy as compared to previous techniques.
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