Is median sternotomy invasive? A comparison between minimally invasive direct coronary artery bypass and off-pump bypass

Surgery Today ◽  
2000 ◽  
Vol 30 (6) ◽  
pp. 503-505 ◽  
Author(s):  
Nobuaki Hirata ◽  
Yoshiki Sawa ◽  
Toshiki Takahashi ◽  
Hiroshi Katoh ◽  
Nobukazu Ohkubo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Off Pump ◽  
Pump Bypass

Comparison of early and late quality of life between left anterior thoracotomy and median sternotomy off-pump coronary artery bypass surgery

Perfusion ◽  
2016 ◽  
Vol 32 (1) ◽  
pp. 50-56
Author(s):  
Julian J. Nesbitt ◽  
George Mori ◽  
Charlotte Mason-Apps ◽  
George Asimakopoulos
Keyword(s):  
Quality Of Life ◽  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Off Pump ◽  
Pump Coronary Artery Bypass ◽  
Oral Analgesia

Objective: Minimally invasive coronary artery bypass surgery performed through a left thoracotomy has potential benefits over conventional sternotomy, including reduced surgical trauma, faster recovery and potential improvement in quality of life. This study is a prospective assessment of quality of life in patients undergoing off-pump coronary bypass by median sternotomy and left anterior thoracotomy. Methods: Quality of life was assessed by the EuroQoL questionnaire, with additional questions on dyspnoea, angina, wound pain and scar aesthetics. Outcomes were compared across the data sets at pre-operation, three weeks and three months post-operation. Results: Sixty-six (17 minimally invasive and 49 off-pump) patients (mean age 65±12, 7 females and 59 males) were included. Significant differences in mean EuroQol outcomes were observed for activities, F(1,64) = 5.86, (p<0.05), pain scores, F(1,64) = 4.658 (p=0.035) and scar aesthetics, F(1,64) = 16.83 (p<0.05). There was an additional significant interaction, F(1.898, 121.49) = 3.282, (p<0.05), between time and group for activity levels; exploring this further indicated no significant difference at baseline, but significantly greater improvement observed in the minimally invasive group over time. At 3 weeks, 50% of minimally invasive patients compared to 82% of sternotomy patients (p<0.001) required oral analgesia. At 3 months, 8% of minimally invasive patients and 21% of sternotomy patients (p<0.001) required oral analgesia. Conclusions: Off-pump coronary artery bypass performed with a minimally invasive approach through a left thoracotomy appears to result in earlier improvement in quality of life outcomes compared to conventional sternotomy. These results are important when counselling patients regarding the benefits and difference between a left anterior thoractomy MIDCABG and conventional OPCAB and can be used as pilot data for a larger trial examining differences in the MIDCABG and conventional full sternotomy OPCAB procedures.

Exposures of Lateral and Inferior Cardiac Surface for Coronary Anastomosis during Minimally Invasive Coronary Artery Bypass Grafting

2015 ◽  
Vol 10 (1) ◽  
pp. 73-75 ◽  
Author(s):  
Shantanu Pande ◽  
Devendra Gupta ◽  
CR Siddartha ◽  
Anubhav Bansal ◽  
Surendra K. Agarwal
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Inferior Surface ◽  
Off Pump

Exposure of the lateral and inferior surface of the heart during off-pump coronary artery bypass grafting is associated with some degree of cardiac instability during recovery with completion of grafting. Exposure of lateral and posterior surfaces by currently available equipment is difficult in minimally invasive coronary artery bypass grafting (MICABG) owing to limited exposure. We describe an effective variation of often-used technique of pericardial stitch in exposure of cardiac surfaces during MICABG. This technique was used in 24 patients undergoing multivessel MICABG. Deep pericardial sutures were used to manipulate the exposure of cardiac surfaces. Left anterior descending artery was grafted in all 24 cases. Obtuse marginal artery was grafted in 20 cases and posterior descending artery in 12 cases. Average grafts were 2.3 per patient. There was no conversion to median sternotomy. Use of deep pericardial suture is simple technique for exposure of lateral and inferior surface during multivessel MICABG. This offers adequate exposure and operating space for easy maneuverability.

Robot-Assisted Off-Pump Minimally Invasive Reoperative Coronary Artery Bypass Grafting: Case Report

2004 ◽  
Vol 7 (6) ◽  
pp. E533-E534 ◽  
Author(s):  
Timothy P. Martens ◽  
Marco M. Hefti ◽  
Robert Kalimi ◽  
Craig R. Smith ◽  
Michael Argenziano
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Robot Assisted ◽  
Artery Bypass Grafting ◽  
Off Pump

scholarly journals Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy

2013 ◽  
Vol 95 (7) ◽  
pp. 481-485 ◽  
Author(s):  
R Birla ◽  
P Patel ◽  
G Aresu ◽  
G Asimakopoulos
Keyword(s):  
Coronary Artery ◽  
Blood Transfusion ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Off Pump ◽  
Opcab Group ◽  
Significant Difference ◽  
The Mean

Introduction Although it is not a new technique, minimally invasive direct coronary artery bypass (MIDCAB) is employed only by a few surgeons in the UK. We compared our experience with MIDCAB with that of single vessel off-pump coronary artery bypass (OPCAB) graft surgery through a standard median sternotomy. Methods Patients who underwent either MIDCAB or OPCAB between April 2008 and July 2011 were reviewed. Exclusion criteria included patients with an ejection fraction of <0.5 or previous cardiac surgery. Data were obtained retrospectively from our prospective database, medical records and through general practitioners. Results Overall, 74 patients were analysed in the MIDCAB group and 78 in the OPCAB group. Their demographics and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values were comparable (p>0.05). There was no statistically significant difference in the two groups in terms of mortality, recurrent myocardial infarction, postoperative stroke, wound infection, atrial fibrillation or need for reintervention. The MIDCAB group had six conversions to a sternotomy. Eight patients in each group required blood transfusion, with the average transfusion being 1.8 units in the MIDCAB group and 3.2 units in the OPCAB group. The mean duration of ventilation and intensive care unit stay was 5.0 hours and 38.4 hours in the MIDCAB group and 5.4 and 47.8 hours in the OPCAB group. The mean hospital stay was significantly reduced in the MIDCAB population (6.1 vs 8.5 days, p<0.05). Conclusions MIDCAB can be performed safely in appropriately selected patients with outcomes comparable with OPCAB. The potential benefits include shorter hospital stay, reduced need for blood transfusion and faster recovery.

Coronary Artery Bypass Grafting using Bilateral Internal Thoracic Arteries through a Left-Sided Minithoracotomy: A Single-Center Starting Experience

2018 ◽  
Vol 67 (06) ◽  
pp. 437-443 ◽  
Author(s):  
Mahmoud Diab ◽  
Gloria Färber ◽  
Christoph Sponholz ◽  
Raphael Tasar ◽  
Thomas Lehmann ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Term Survival ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Sf 36

Abstract Background Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) is associated with the best long-term survival. However, using BITA increases the risk of sternal wound infections with conventional sternotomy. We describe here our initial results of minimally invasive CABG (MICS-CABG) using BITA. Methods Patients were operated through an incision similar to that of standard minimally invasive direct CABG. All operations were performed off-pump. We evaluated patient's quality of life (QoL) using the Medical Outcomes trust, 36-Item Short Form Health Survey (SF-36). Results Between February 2016 and August 2017, we performed 21 cases of MICS-CABG using BITA. There was no intraoperative complication and no conversion to sternotomy or to on-pump. Two patients required reexploration through the same minithoracotomy for postoperative bleeding. Two cases of early postoperative graft failure were identified. There was no stroke or in-hospital mortality. The median duration of follow-up was 13 months, with a maximum of 19 months. Relief of angina was achieved in all patients. There was one readmission for superficial wound infection, which was conservatively treated. An 84-year-old man died 4 months after the operation. The remaining 20 patients attested good QoL with the SF-36 questionnaire. Conclusions Myocardial revascularization using BITA can be safely achieved off-pump through a left-sided minithoracotomy with good postoperative and short-term outcomes.

Experimental Coronary Artery Occlusion: Relevance to Off-Pump Cardiac Surgery

2002 ◽  
Vol 10 (4) ◽  
pp. 293-297 ◽  
Author(s):  
Charles Hsi ◽  
Henri Cuenoud ◽  
Babs R Soller ◽  
Hun Kim ◽  
Janice Favreau ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Artery Dissection ◽  
Graft Occlusion ◽  
Off Pump

Mechanical coronary artery occlusion is required for minimally invasive direct coronary artery bypass and off-pump coronary artery bypass surgery. It is important that the method of occlusion be minimally traumatic. Chronic effects of these methods have never been studied. Temporary occlusion of coronaries utilizing suture snare, silastic loop snare, and bulldog clamp was carried out in 12 Yucatan pigs. Three animals each were sacrificed acutely and at 3, 6, and 12 months. The area of occlusion of each vessel was examined by light microscopy and the degree of damage recorded. In the animals sacrificed acutely, there was more damage using the suture snare than with the other 2 methods, but there was minimal damage at longer intervals. There was slight damage acutely and chronically with the bulldog technique. No damage was seen acutely with the silastic loop technique, but some late damage was found. The techniques of coronary artery dissection and occlusion used for minimally invasive and off-pump bypass surgery may contribute to early postoperative graft occlusion.

Minimally invasive coronary artery bypass grafting: port-access approach versus off-pump techniques

1998 ◽  
Vol 66 (3) ◽  
pp. 1036-1040 ◽  
Author(s):  
Hermann Reichenspurner ◽  
Dieter H Boehm ◽  
Armin Welz ◽  
Christoph Schmitz ◽  
Stephen Wildhirt ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Off Pump ◽  
Port Access
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