Multivessel Minimally Invasive Coronary Artery Bypass Grafting: A Single Center Experience
Taichi Sakaguchi, Masaaki Ryomoto, Naosumi Sekiya, Hiroe Tanaka, Mitsuhiro Yamamura.
Hyogo College of Medicine, Nishinomiya, Japan.
Objective: Minimally invasive coronary artery bypass grafting (MICS CABG) has been gaining population. However, multivessel MICS CABG is routinely performed in only a few centers. We evaluated the safety and feasibility of multivessel MICS CABG. Methods: Since December 2012, 82 patients underwent multivessel MICS CABG via a left minithoracotomy under direct vision. Bilateral internal thoracic arteries (BITAs) were used in 41 patients (50%), with the second ITA as an in situ graft (n=22) or free graft (n=19). Proximal anastomoses of the free graft (ITA, radial artery or saphenous vein segments) were performed directly onto the ascending aorta or from the ITA as a Y- or I-composite graft. Cardiopulmonary bypass was used in 17 patients (20.7%). The aortic no-touch technique was used in 31 patients (37.8%). Results: The patients ranged in age from 38 to 85 years old (mean 64 ± 9 years old), and 70 were male. Mean graft number was 2.3 ± 0.5 (range 2-4). There were no cases of in-hospital death, stroke, chest wound infection or reoperation for any reason. The early graft patency was 96.8%. During the mean follow-up period of 720 ± 599 days, two patients died for an accident or unknown reason. Freedom rate from major adverse cardiac and cerebrovascular event (all-cause death, myocardial infarction, stroke, repeat revascularization) was 95.9% at 5 years. Conclusions: Multivessel MICS CABG is feasible and has good mid-term outcomes. BITAs can be harvested through this approach, allowing for various graft designs. It can be a useful option for coronary revascularization in select patients.
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