Complete Revascularization In Mics Cabg - Is It Possible & Accessible Anywhere?
Waldo Emerson Pinheiro Daniel, MD Prof, Ricardo Jorge Queiroz e Silva, MD, Waldo Emerson Pinheiro Daniel Filho, MS.
Federal University of RN-UFRN, Natal, Brazil.
BACKGROUND: Coronary artery bypass graft (CABG) is considered the gold standard for the treatment of coronary artery disease. However, this not risk free. In order to mitigate such risks and possible complications, minimally invasive cardiac surgery (MICS) has emerged. The aim of this study is to demonstrate the feasibility of complete revascularization in patient undergoing MICS-CABG, and lower complication rates. Besides showing that it is possible to perform procedure with usual instruments, not specific for MICS and with good result. METHODS: Our service has selected 132 patients with indication for surgical myocardial revascularization between 2014 and 2017. Of these, 71.21% were male and 28.79% female. We had two morbidly obese patients (BMI 42,39 & 44,98). For these procedures, Finochietto retractor, MEDTRONIC Evolution or MAQUET Acrobat or ESTECH Stabilizer were used. Usual Instrumental was used. The patients underwent coronary angiotomography at 6 Months.
RESULTS: A total of 100% of the patients underwent MICS-CABG without the use of extracorporeal circulation. The age ranged from 40 to 89 years. The number of revascularized arteries was five in 9.09% patients, four in 9.09%, three in 33.33%, two in 28.03% and one in 20.45%. Postoperative Bleeding significantly smaller. Average hospital stay was eighty four hours. No reoperation or conversion to sternotomy. Um MI, after one month, but without clinical/hemodinamic repercussion and was treated clinically. Graft Patency at 6 months: LITA 100%, SVG 89%. No death.
CONCLUSIONS: All patients received complete revascularization. That is, the alternative access route to sternotomy - the left anterolateral minithoracotomy, allows adequate exposure for access to all coronary arteries and offers a lower chance of complications and faster recovery of these patients. In addition, it is possible through this technique to perform surgeries without the use of CPB avoiding its deleterious implications. The fact that this work has been used usual instruments not specific for MICS, reinforces the reproducibility and accessibility of most diverse surgeons, considering the places where they are and his reality. Special instruments, help and bring comfort to the surgeon, but its absence should not be impeditive to the procedure.
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