MIDTERM RESULTS OF TOTAL ARTERIAL BYPASS
PRAKASH MANOHARLAL LUDHANI, SAGAR BHARAT SAHITA, KETAV LAKHIA, Chirag Doshi, Dr.
U N MEHTA INSTITUTE OF CARDIOLOGY AND RESEARCH CENTRE, AHMEDABAD, India.
BACKGROUND: Midterm result of minimally invasive total arterial coronary revascularization
METHODS: Patients who underwent total arterial minimally invasive coronary artery bypass surgery between June 2017 to June 2020 at single centre U N Mehta Institute of Cardiology and Research centre.The study is Prospective patients operated from December 2018 to June 2020 and Retrospective patients operated from June 2017 to December 2018
RESULTS: From June 2017 to June 2020, coronary artery bypass surgery was done in 4852 cases at our centre over three year period of which 247 cases were total arterial minimally invasive coronary revascularization(5.09%).Out of the 436 (8.99%) minimally invasive surgery cases done during this 3 year period ,247 (56.65%) were total arterial coronary artery bypass surgery.Mean age 57.3+/- 9.8 years, Male: Feamle- 149:98, Coronary artery disease Type :(single vessel - 18.2%, double vessel -59.5%,Triple vessel-22.3%)Preoperative Left ventricle ejection fraction- 51.5 +/-10.5.Total number of grafts- 504.LIMA-LAD-247 (100%), LIMA-DIAGONAL-LAD SEQUENTIAL- 9(3.64%),LIMA-RIMA-OM-127(51.4%), LIMA-RIMA-OM-PDA-49 (19.8%) , LIMA-RADIAL-OM -11(4.45%), LIMA-RADIAL-OM-PDA-6(2.43%)LAD Endarterectomies 8(3.24%), IABP-4 (1.62%), CPB -2 (0.81%). Sternotomy- 1(0.4%), Blood transfusion- 57(23.1%), Mean ventilation time- 8.9+/-5.4hrsICU stay- 1.06+/- 0.56 days, Hospital stay -5.03+/- 1.46 daysFollow up : Patient lost to follow up 32 (12.95%) Patient not willing for CT angiogram 45(118.21%) Patient with altered Renal function not subjected to CT 27(10.93%) Total number of grafts assessed by CT angiography 352 (69.84%)Only 3 grafts were completely occluded ( 1 -LIMA-LAD, 1 RIMA Y to PDA, 1 Radial Y to OM).Fitzgibbon Score A -334 (94.89%), Fitzgibbon Score B-15 (4.26%), Fitzgibbon Score O- 3 (0.85%). Re-exploration in 2 patients CONCLUSIONS: Total arterial multi vessel coronary revascularization through left minithroacotomy is feasible, safe, reproducible and better approach considering early mobilisation, short intensive and hospital stay and better comesis especially in females.
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