Redo Sternal-sparing Minimally Invasive Off-pump Coronary Artery Bypass Grafting
Doosang Kim, Bou Sung Lee, Hee Jung Jeon, Hong-Gook Lim.
Seoul Veterans Hospital, Seoul, Korea, Republic of.
Objective: Redo CABG is still major concern to cardiac surgeons due to high mortality and morbidity. Off-pump technique and minimally invasive approach, which avoids redo-sternotomy, could provide safe combination to treat recurring coronary atherosclerosis. Therefore, we evaluated the feasibility of redo sternal-sparing minimally invasive off-pump CABG. Methods: From April 1998 to October 2018, among the 680 CABG patients, we conducted redo sternal-sparing minimally invasive approach in 35 (5%) patients and these are subjects. Age was 70 (58-83) years old and all male. Sternal-sparing coronary access routes were left anterior small thoracotomy in 19, inverted-U laparotomy in 9, and para-sternal vertical thoracotomy in 7.
Results: Time interval between 1st and redo was 10.5 (0.25-20.8) years. Timing of redo was no acute failure within 1 month, early failure within 1 year in 3 (9%) at median 7.5 months, midterm failure within 3-4 years in 4 (11%) at 2.3 years, and delayed failure more than 5 years later in 28 (80%) at 11.3 years. Reason for redo was newly-developed coronary lesion in 5 (14%), remnant coronary disease progression in 4 (11%), and previous graft failure in 26 (74%). Failed grafts were LITA/RITA-to-LAD in 12, non-LAD arterial graft in 12 and non-LAD vein graft in 6. Operative time was 275 minutes and no on-pump conversion but intraoperative IABP support in 8 (23%). Postoperative stays in ICU and floor were 2 and 14 days, respectively. There were 4 mortalities (11%: asphyxia, ARDS/enteritis, ventricular fibrillation and ulcer bleeding on postoperative days 0, 2, 9, 22, respectively) and 12 morbidities (34%). 4-year overall, cardiac and MACCE-free survival rates were 79%, 82% and 70%, respectively.
Conclusions: Conducting redo sternal-sparing minimally invasive OPCAB surgery is feasible.
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