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No-sternotomy full arterial revascularization for everyone
Boris Robic, Dr, Pascal Starinieri, Alaaddin Yilmaz, Dr.
Jessa Hospital, Hasselt, Belgium.

OBJECTIVE: Minimal invasive procedures emerge in cardiac surgery due to well-known drawbacks.
Sternotomy is still mandatory for OPCAB surgery.MIDCAB surgery is limited to revascularization of anterior wall.
Detrimental effects of conventional bypass systems-Minimal access is not allways minimal invasive.
Endoscopic assisted port access approach for coronary artery bypass grafting (EndoCABG) combines full revascularization without sternotomy.
Modular minimal invasive extracorporeal circulation (MiECC)- reduces deleterious bypass-effects and supports surgeons efforts in minimal invasive techniques.
METHODS: Miocardial ischemic patients with multivessel disease not suitable for hybrid approach.
Possibility for remote access perfusion with MiECC: a low volume-small surface-full safety circuit requiring lower heparin dosage.
Ongoing dual anti-platelet therapy was no contraindication.
RESULTS: From July 2014 to December 2015, 145 patients average age 66,61 years (range 36-90), 81 (%) male, 19 (%) female, underwent Port Access surgery-EndoCABG.
Full arterial revascularization was accomplished in 98% with the use of VATS uni-/bilateral internal thoracic artery (ITA) harvesting.
In average 2,86 (range 2-5) Video assisted direct anastomoses were accomplished via small left thoracotomy. Complete revascularization was achieved in 46% on empty beating heart and 54% on arrested heart(remote access perfusion with MiECC). Crossclamp time (when applied) was in average 65,45 min with normal operation duration of 2,5-3h.
CONCLUSIONS: Minimal invasive surgery is a team approach. Use of MiECC flattens the steep learning curve in adapting port access techniques for coronary artery bypass grafting.
Better outcome due to possibility of full arterial revascularization
Maximum benefit is accomplished only through refinement of both-surgical and perfusion techniques.

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