Conventional Arterial Coronary Bypass Surgery; Endoscopic Approach
Alaaddin Yilmaz, Silke Van Genechten, Boris Robic, Pascal Starinieri.
Jessa Hospital, Hasselt, Belgium.
Background: Evolution in coronary bypass surgery by means of minimal invasive access has taken enormous steps forward, especially in single vessel disease. We want to share our experience in multivessel coronary bypass surgery by endoscopic set up in combination with use of minimal extracorporeal circulation (MiECC). Methods: From January 2016 to December 2017, 400 consecutive patients (mean age 67.1±9.8 years) of which 10% octogenarians, received surgery for multivessel coronary artery disease. Patients received either single or double totally endoscopic internal mammary artery (IMA) prelevation, followed by groin cannulation and connection to MiECC. The anastomoses were performed through 2 inch incision with direct vision. Aorta was clamped using transthoracic clamp and cold mixed blood cardioplegia (3:1 ratio) was administered through percutaneous manner. Results: Mean anastomoses were 2.5 ± 0.9. Clamping and bypass times were 51.4±32.1 and 98.4±39.5 minutes, respectively. The mean length of stay at the intensive care unit and the hospital were 77.7±73.6 hours and 9.5±7.6 days, respectively. Mortality rate was 1.75% with EuroSCORE of 1.3±5.9. Conclusion: The procedure is feasible with good surgical and cosmetic results. The idea of minimizing the access for IMA prelevation, together with performing the bypasses, have reached its non-sternotomy access which is eligible for all cases.
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