Tips Which We Generalised After 500 Consecutive Multivessel Minimally Invasive On-pump CABG Cases
Volodymyr Demianenko, Oleksandr Babliak.
Diagnostic and Treatment Center For Children And Adults Of The Dobrobut Medical Network, Kyiv, Ukraine.
BACKGROUND: To present our experience and lessons that we have learnt in 500 cases of minimally invasive CABG.
METHODS: From July 2017 to May 2021 we operated on 508 consecutive patients with isolated multivessel coronary artery disease. Out of them in 500 (98.4%) patients we performed complete coronary revascularization through the left anterior minithoracotomy with cardiopulmonary bypass, Chitwood clamp and intermittent blood cardioplegia (TCRAT technique). Special exposure maneuvers were used to reduce the distance from skin to coronary targets. Usual coronary instruments were used.
RESULTS: 98.4% of all incoming patients for CABG could be safely operated with TCRAT technique. All coronary targets could be reached with distance within 6 cm from skin level (distance to LAD - 4.47 ± 0.4 cm, OM - 5.95 ± 0.75 cm, PDA - 5.5 ± 0.4 cm). LIMA was used in 97% of patients. In all cases LIMA was transected in the 4th ICS and this length was enough to reach all segments of LAD. The uniarterial grafting strategy (LIMA and veins) or the total arterial grafting strategy (LIMA and radial artery or RIMA) could be used. The aortic cross-clamp time for the uniarterial grafting strategy was - 67.5 ± 17.9 min (range, 34 - 133), for the total arterial grafting strategy was - 76.7 ± 19.1 min (range, 39 - 126).Most complications could be effectively managed through the same incision. The complication that required conversion to sternotomy was the aortic dissection (n - 2). In selective cases (n - 41) we were performed TCRAT procedure with concomitant MV repair/replacement (n - 17) or/and LV aneurysm repair (n - 24) through the left anterior mini-thoracotomy with the satisfactory results.
CONCLUSIONS:Multivessel minimally invasive on-pump CABG through the left anterior mini-thoracotomy could be routinely used regardless of the number of grafts, the left ventricular ejection fraction, the quality and size of the coronary vessels and the age of the patients. Selective patients with CAD and concomitant MV insufficiency or/and LV aneurysm could be operated through the left anterior mini-thoracotomy.
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