Total Coronary Revascularization Via Left Anterior Thoracotomy
Volodymyr Demianenko, Oleksandr Babliak.
Diagnostic and Treatment Center For Children And Adults Of The Dobrobut Medical Network, Kyiv, Ukraine.
Background. Our aim was to develop the minimally invasive coronary artery bypass grafting (CABG) technique, which will be equally effective and safe comparing with conventional CABG technique, will be reproducible and will be applied in every patient with isolated coronary artery disease. Since July 2017 we started to perform multivessel CABG routinely through the left anterior minithoracotomy in all patients. Methods. From July 2017 to November 2018 a total of 170 non-selected consecutive patients underwent minimally invasive on-pump multivessel coronary artery bypass grafting through the left anterior 6-8 cm thoracotomy in the 4th intercostal space using Chitwood clamp and blood cardioplegia. We named this technique - total coronary revascularization via left anterior thoracotomy (TCRAT). There were 150 (88.2%) male and 20 (11.8%) female patients. Mean age was 62.6 ± 9.8 years (range, 31 - 86). Mean weight was 89.6 ± 15.0 kg (range, 54 - 160), mean body mass index - 30.3 ± 4.0 (range, 21.6 - 47.8). Left ventricle ejection fraction was 52.3 ± 9.9 (range, 15 - 70). Results. With TCRAT technique we had no mortality, no perioperative myocardial infarcts, no conversion to sternotomy. There were two perioperative strokes without residual neurological deficit and two revisions for postoperative bleeding. The mean number of grafts was 3.1 ± 0.7. Left internal mammary artery was used in 159 (93.5%) patients, right internal mammary artery - in 4 (2.4%) patients, radial artery - in 25 (14,7%) patients, veins - in 148 (87%) patients. The average distance from skin level to coronary targets was 6cm. The total operation time was 258.8 ± 43.9 (range, 205 - 360) minutes, cardiopulmonary bypass time - 135.8 ± 26.6 (range, 115 - 187) minutes, aortic cross clamp time - 71.2 ± 19.4 (range, 45 - 118) minutes. The mean intensive care stay was 2.1 ± 0.56 (range, 1-5) days, mean total hospital stay - 6.3 ± 1.3 (range, 4 - 11) days.
Conclusions. Complete multivessel coronary revascularization could be routinely performed minimally invasively using TCRAT technique, regardless number of grafts, quality and location of coronary vessels, left ventricle function, age, gender, body mass index.
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