Minimally Invasive Multivessel Coronary Bypass Surgery: Angiographic Patency Data
Mikhail Snegirev, Artem Paivin, Dmitriy Denisyuk, Nikolai Khvan, Andranik Tatoyan, Lana Sichinava, Vladimir Sharafutdinov, Oleg Paivin.
City hospital 40, Saint-Petersburg, Russian Federation.
BACKGROUND: Minimally invasive multivessel coronary bypass grafting (MICS CABG) has shown its safety, effectiveness and high rates of reproducibility. It is associated with fewer perioperative complications, but data on graft patency is lacking. In this single-center study we retrospectively analyse angiographic data on graft patency along with mid-term follow-up in low to high-risk patients, subjected to MICS CABG. METHODS: 240 Patients were operated between 2014 and 2018. All patients were subjected to MICS CABG by small left side thoracotomy (7-10 cm). To achieve controllable hypotension and bradycardia, high epidural block was used in every case (level of Th4-Th5). Left internal thoracic artery harvesting, proximal anastomoses with ascending aorta and distal anastomoses were performed under direct vision. Saphenous vein/radial artery grafts were harvested endoscopically. Intraoperative transit time flowmetry (TTFM) has been used routinely. In 7 cases full arterial revascularization was performed. Patients were followed up and examined with 128-slice computed tomography coronary angiography. Angiographic data has been achieved for 127 (52,9%) patients (mean follow-up 31.1±7.8 months, range 15 - 42 months).RESULTS: Mean number of grafts was 2.6±0.5 with all distal target regions accessed. Perioperative mortality was 1 patient (0.4%). There were 2 conversions to sternotomy (0.8%) and 4 reopenings for major bleeding (1.7%). There were 3 perioperative myocardial infarctions (1.3%) and 1 perioperative stroke (0.4%). Blood components were transfused to 16 patients (6.7%). At 31.1 months postoperatively, overall survival was 97.1%. Stroke at follow-up occurred in 2 patients (1.9%). Repeat revascularization (percutaneous coronary intervention) was performed in 2 patients (0.8%). Overall graft patency rate was 87.5%. Most frequently occluded graft was a saphenous vein to left circumflex (9 grafts, 30,0%). Internal thoracic artery graft patency rate was 98.4%. CONCLUSIONS: MICS CABG allows full surgical revascularization with usual alignment of grafts. Excellent perioperative and mid-term results along with promising angiographic graft patency data has been achieved. LEGEND: Figure 1. Transit time flow measurement data after MICS CABG. LAD - Left Anterior Descendent, Diag - Diagonal Branch; LCx - Left Circumflex, OM - Obtuse Marginal, RCA - Right Coronary Artery, PDA - Posterior Descendent Artery.
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