Extending The Boundaries Of Coronary Revascularization Through The Minithoracotomy
Volodymyr Demianenko, Oleksandr Babliak
Diagnostic and Treatment Center For Children And Adults Of The Dobrobut Medical Network, Kyiv, Ukraine
To present the surgical steps of multivessel minimally invasive coronary revascularization through the left anterior thoracotomy.
From July 2017 to November 2019 we operated on 328 consecutive patients with isolated multivessel coronary artery disease. Out of them in 321(97.8%) patients we performed complete coronary revascularization through the left anterior minithoracotomy (6-8 cm skin incision). Cardiopulmonary bypass (CPB) with peripheral cannulation, Chitwood clamp and intermittent blood cardioplegia were used in all patients. Special exposure maneuvers were used to reduce the distance from skin to coronary targets. Usual coronary instruments were used. Left internal mammary artery was used as conduit in 302 (94.1%) of patients, right internal mammary artery - 5 (1.6%), radial artery - 66 (20.6%), veins - 276 (85.9%).
Hospital mortality was 0.3%. There was no conversion to sternotomy. In total, 968 distal coronary anastomoses were performed, 489 proximal aortic anastomoses were performed and 70 T-shunts were constructed. The mean number of distal anastomoses was 3.1 ± 0.65 (2; 5). Mean aortic crossclamp time was 69.8 ± 18.5 (31; 127) minutes, CPB time - 138.6 ± 29.7 (71; 241) and total operation time - 264.2 ± 50.4 (145; 495). Total hospital stay was 5.9 ± 1.56 (3; 12).
Multivessel coronary bypass grafting through the left anterior minithoracotomy using CPB and cardioplegia is reproducible method of surgical revascularization. It can be safely applied in up to 97.8 % of patients with isolated coronary artery disease.
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