Non Rib Spreading Minimally Invasive Coronary Artery Bypass Grafting For Multi Vessel Disease
Gentaku Hama.
Saku Central Hospital, Saku, Japan.
BACKGROUND Minimally invasive coronary bypass grafting (MICS-CABG) has been performed successfully over the past decade. However there is no consensus regarding the strategy for multi-vessel coronary artery disease. This study aimed to compare outcomes between multi-vessel MICS-CABG and Hybrid coronary revascularization. METHODS From February 2013 to November 2017, 44 patients underwent Non-rib-spreading MICS-CABG. Of these, 14 patients underwent multi-vessel MICS-CABG (M group) and 6 patients had hybrid coronary revascularization (H group). The mean number of bypass in M group was 2.14. BITA was used in 10 patients, AC bypass was done in 3 patients. SVG or RA grafts were interposed distally as needed. In H group, single-vessel MICS-CABG(LITA to LAD) was followed by planed PCI to RCA, left main or circumflex. RESULTSAge(M vs H; 68.5(46-82) vs 69.5(52-74 )years, p=0.68)and risk of surgery (Japan Score: 0.9(0.5-5.8) vs 1.55(0.5-10.7)%)were similar. There were no mortality or major perioperative complications in both groups, except one conversion to sternotomy due to injury of ITA in M group. The operative time(398(345-535) vs 193(155-269)min, p<0.01)and ventilation time(7(1-17) vs3(0-6) hour, p=0.03)were shorter in H group. The short-term patency of grafts was 89% in M group and 100% in H group, 3 patients in M group required additional PCI. No patient complained postoperative severe pain.CONCLUSIONS Non-rib-spreading MICS-CABG was safe and feasible option for patients with multi-vessel coronary disease. Hybrid therapy by single-vessel MICS-CABG and PCI might have potential to promote faster recovery.
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