Surgical Results Of Minimally Invasive Coronary Artery Bypass Grafting With Bilateral Internal Thoracic Artery
Keita Kikuchi, Shinji MIzuta, Kan Kaneko.
Ichinomiya Nishi Hospital, Ichinomiya, Japan.
BACKGROUND We have started MICS CABG program from 2012 and had started using BITA from 2014. So far we also have developed our original technique of MICS CABG, such as harvesting BITA with Harmonic Scalpel and displacement of the heart for off pump technique in MICS CABG. METHODS Consecutive142 patients who underwent multi vessel off pump MICS CABG in 172 cases of MICS CABG done by a single surgeon between February 2012 and August 2019 were reviewed retrospectively. All procedure of MICS CABG was performed under direct vision without CPB. The right internal thoracic artery and/or left internal thoracic artery are harvested using a harmonic scalpel with skeletonised fashion. At the same time, other conduits are harvested. Then proximal anastomosis was made on the ascending aorta with side clamp. Distal anastomoses were done with usual suction type tissue stabilizer. We intend to use RITA as an in-situ graft. MICS CABG with BITA were performed in 73 cases (Group B) and without BITA were performed in 69 cases (Group S). These two groups were compared about perioperative factors. RESULTS Average age was significant younger (62.8 vs 67.4, y.o.) and average number of distal anastomosis was significant higher (3.3 vs 2.9) in Group B. Operative time was significant longer in Group B (300.9 vs 258.2, min). Post-operative hospital stay was significant short in Group B (12.1 vs 14.5, day). There were no difference in conversion to sternotomy and usage of CPB, stroke and mortality between two groups. CONCLUSIONS Using BITA in multi vessel off pump MICS CABG via left small thoracotomy under direct vision were done safely. MICS CABG using BITA may have possibility to be a standard revascularization in less invasive CABG.
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