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Early Outcome Of 3d Endoscopic Harvesting Of Internal Mammaly Arteries For Minimally Invasive Coronary Bypass Grafting.
Takahiro Takemura, Takahito Yokoyama, Hirokazu Niitsu, Gentaku Hama, Yasuyuki Toyota, Yasutoshi Tsuda.
Saku Central Hospital Advanced Care Center, Saku, Japan.
OBJECTIVE: Minimally invasive coronary bypass grafting (MICS CABG) was associated with earlier recovery, better cosmetics and fewer morbidities. We performed 3D endoscopic harvesting of internal mammary artery (IMA) for this procedure since 2012. We report the early outcomes after MICS CABG using endoscopic harvesting procedure.
METHODS: 39 patients (4 Female and 35 Male, average age 67 years) underwent MICS CABG using the 3D endoscope between February 2013 and December 2016. The endoscope was inserted at 5th or 6th intercostal space around the anterior axillary line using 12mm port. Another 2 additional 5mm working port were placed. Skeletonized IMA harvesting underwent using Harmonic Scarpel under closing chest and CO2 insufflation through each chest wall. Non-rib spreading anastomotic procedure was performed using 5cm skin incision and soft tissue retractor without cardiopulmonary bypass in all patients. We performed coronary angiography or CT angiography about 1 week after operation in 38 cases.
RESULTS: There were no operative death, major cardiac events, or stroke. 1 patient needed conversion to full sternotomy due to injuries of bilateral IMA. Only left IMA was harvested in 27 patients and bilateral IMA were harvested in 11 patients. 1 patients could not use left IMA due to graft injury. Left IMA was anastomosed to LAD in 37 patients. In situ Right IMA was anastomosed to diagonal branch in 2 patients. Right IMA and saphenous vein composite grafts was anastomosed diagonal branch, or left circumflex branch, or right coronary artery in 9 patients. Graft patency of left IMA was 100% and right IMA was 72%. 8 patients underwent scheduled hybrid PCI after CABG.
CONCLUSIONS: MICS CABG using 3D endoscopic harvesting and non-rib spreading anastomosis is less invasive and painless procedure compared with conventional MICS CABG using direct vison. This procedure is less expensive and less traumatic procedure compared with robotically assisted CABG. The experience of harvesting bilateral IMA is a little and early stage of learning curve. However this procedure might have potential to develop MICS CABG for the patients with multi vessels coronary artery disease with or without hybrid revascularization.
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