Multivessel Coronary Artery Revascularization Through Left Mini-anterior Thoracotomy: A Noble Technique To Overcome Sternotomy
mugisha kyaruzi, yasemen durak erdinc, barış šaynak.
medical park hospital, istanbul, Turkey.
Introduction: Over centuries median sternotomy has a been a gold standard approach for treatment of isolated multivessel coronary artery disease but this traditional approach has been associated with morbidity and mortality. The aim of our study was to present our noble minimal invasive technique (left mini-anterior thoracotomy) of multivessel coronary revascularization which is reliable,safe and applicable to all patients.
Materials and methods: Our study consisted of 104 consecutive non selective patients who were operated with the same surgical team between july 2019 to december 2019 at two different medical centres. Left internal mammalian artery was harvested in all patients by the aid of rib retractor. All patients were operated under cardiopulmonary bypass machine through left minianterior thoracotomy of 5cm-7cm. All saphenous vein grafts were harvested endoscopically (Figure 1)Results (table 1): We had no mortality, no early postoperative myocardial infarction was observed . Only one patient was converted to sternotomy(1.9 %). Four patients had postoperative atrial fiblillation(3.8%), 1 patient suffered postoperative stroke(resolved without neurologic deficit)(1.9%), 3 patients had revision due to postoperative bleeding(5.7%). The mean number of bypass was 3.3 ▒0.8, cross clamping time was 95.7 ▒ 41.0 minutes, cardiopulmonary bypass time was 159.2 ▒ 46.5 minutes,entubation time was 6.7▒ 1.9 hours, intensive care unit(ICU) stay was 1.2▒ 0.6 days, hospital stay was 5.3▒ 2.7 days. Conclusion: Left anterior minithoracotomy approach(5cm-7cm) for total coronary revascularization is safe,reliable,reproduciable procedure for routine treatment of isolated coronary lesions regardless of their numbers,location, ventricular function and patients characteristics. <![endif]-->
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