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Midcab As The Sole Approach For Primary Coronary Artery Bypass Grafting-an Indian Single Centre Study
Sushan Mukhopadhyay, Arumit Palit, Tamashis Mukherjee.
Apollo Multispeciality Hospital, Kolkata, India.
BACKGROUND:Coronary artery bypass grafting (CABG) remains the cornerstone of surgical revascularization for patients with significant multivessel coronary artery disease. Although till date, CABG performed via median sternotomy, is most common approach, but it"s associated with substantial surgical trauma, prolonged recovery, sternal wound infection, and increased perioperative morbidity. Large case series showed that Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) has high graft patency (94%) with low mortality and superior long-term survival. The various contraindications of MICS mentioned in the literature can be bypassed by modification of techniques of MICS and Anesthesia and it should be regarded as primary approach for CABG. We present our study over 04 years over 1007 patients where MIDCAB were performed as default.
METHODS:We retrospectively studied last 04 years (2022-2025) data of primary CABG in our centre. The primary approach for CABG was MIDCAB irrespective of patients" clinical status, demography and coronary angiography findings. Redo and composite cases were excluded from the study. We studied average number of grafts, requirement of CPB (Cardiopulmonary Bypass), incidence of conversion to sternotomy and re-exploration and follow up of the patients. Primary target grafts were LIMA to LAD and RSVG to others. LIMA-RSVG -Y and LIMA-RIMA -Y conduit were used for calcified proximal aorta.
RESULTS: Total 1007 MIDCAB cases were performed in 4 years period (2022-2025). 01 , 02, 03 and > 3 grafts were used in 55 (5.46%), 285(28.30%), 332(32.96%) and 335 (33.28%) cases respectively. Maximum grafts used in a patient was 06 grafts. Requirement of CPB was for 9.7 % of cases (4.3% for hemodynamic instability, 5% for large heart and 0.4% for not tolerating one lung ventilation). Only 01 case required conversion to sternotomy. Reexplanation rate was 4.2% (42 patients). Only 20 patients (5%) patients had anginal symptoms/ blockage of venous graft in follow up coronary angiography.
CONCLUSION:MIDCAB should be considered the primary surgical approach for CABG irrespective of patient demographics and diseases, particularly within specialized centers possessing appropriate expertise. MIDCAB with its robust clinical outcomes, less hospital stays and good graft patency and fewer complication , supports a paradigm shift away from routine median sternotomy.
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