Coronary artery bypass grafting - Is it time to do away with Sternotomy?
Pradeep NAMBIAR, Kailash SAKSENA.
MOOLCHAND MEDCITY, NEW DELHI, India.
OBJECTIVE: For the last 40 years traditional CABG with full sternotomy has been the standard for coronary revascularization in multivessel coronary artery disease. In an effort to improve CABG outcomes and to reduce surgical trauma minimally invasive approaches to coronary revascularization utilizing bilateral internal thoracic arteries through a mini thoracotomy have been developed. Our aim was to study the safety, outcomes and durability of this technique of minimal access CABG and look at the feasibility of doing away with median sternotomy
METHODS: From August 2011 to November 2014, a total of 560 patients underwent off-pump minimally invasive multivessel CABG using BITAs, through a 2-in left minithoracotomy incision. Both internal thoracic arteries were harvested directly under vision, and complete revascularization of the myocardium was done using the LITA-RITAY composite conduit.
RESULTS: 560 patients had minimally invasive total arterial myocardial revascularization using BITAs (LITA-RITA Y composite conduit) via a left minithoracotomy. The mean number of grafts was 3.1. Ejection fraction was 38.5 +/- 5.2. There were 4 mortalities (0.7%) but no major morbidity. 3 patients required reexploration for bleeding The mean hospital stay was 3.1 days. 4 patients (0.7%) had an elective conversion to sternotomy
CONCLUSIONS: Minimally invasive CABG using this approach is safe and reproducible, with results comparable to standard CABG. Further, the usage of bilateral internal thoracic arteries without a sternotomy maximizes the advantages of myocardial revascularization. We feel that minimal access approaches will phase out median sternotomy in the near future.
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