The Comparison between Minimally Invasive Coronary Bypass Grafting Surgery and Conventional Bypass Grafting Surgery in Proximal LAD Lesion

2015 ◽  
Vol 18 (2) ◽  
pp. 042 ◽  
Author(s):  
Mehmet Ezelsoy ◽  
Baris Caynak ◽  
Muhammed Bayram ◽  
Kerem Oral ◽  
Zehra Bayramoglu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Robotic Group ◽  
Bypass Group

<strong>Background</strong>: Minimally invasive bypass grafting surgery has entered the clincal routine in several centers around the world, with an increasing popularity in the last decade. In our study, we aimed to make a comparison between minimally invasive coronary artery bypass grafting surgery and conventional bypass grafting surgery in isolated proximal left anterior descending artery (LAD) lesions. <br /><strong>Methods</strong>: Between January 2004 and December 2011, patients with proximal LAD lesions, who were treated with robotically assisted minimally invasive coronary artery bypass surgery and conventional bypass surgery, were included in the study. In Group 1, coronary bypass with cardiopulmonary bypass and complete sternotomy were applied to 35 patients and in Group 2, robotically assisted minimally invasive bypass surgery was applied to 35 patients. The demographic, preoperative, perioperative, and postoperative data were collected retrospectively.<br /><strong>Results</strong>: The mean follow-up time of the conventional bypass group was 5.7 ± 1.7 years, whereas this ratio was 7.3 ±1.3 in the robotic group. There was no postoperative transient ischemic attack (TIA), wound infection, mortality, or need for intra-aortic balloon pump (IABP) in any of the patients. In the conventional bypass group, blood transfusion and ventilation time were significantly higher (P &lt; .05) than in the robotic group. The intensive care unit (ICU) stay and hospital stay were remarkably shorter in the robotic group <br />(P &lt; .01). The postoperative pneumonia rate was significantly higher (20%) in the conventional bypass group <br />(P &lt; .01). Postoperative day 1 pain score was higher in the robotic group (P &lt; .05), however, postoperative day 3 pain score in the conventional bypass group was higher (P &lt; .05). Graft patency rate was 88.6% in the conventional bypass group whereas this ratio was 91.4% in the robotic bypass group, which was not clinically significant (P &gt; .05).<br /><strong>Conclusion</strong>: In isolated proximal LAD stenosis, robotic assisted minimally invasive coronary artery bypass grafting surgery requires less blood products, is associated with shorter ICU and hospital stay, and lesser pain in the early postoperative period in contrast to conventional surgery. The result of our studies, which showed similarities to the past studies, lead us to recognize the importance of minimally invasive interventions and the need to perform them more frequently in the future.

scholarly journals Coronary Bypass Surgery in a 105-Year-Old Patient with Cardiopulmonary Bypass

2010 ◽  
Vol 2010 ◽  
pp. 1-3
Author(s):  
Temucin Noyan Ogus ◽  
Filiz Erdim ◽  
Ozer Selimoglu ◽  
Fatih Tekiner ◽  
Murat Ugurlucan
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Management Strategy ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Coronary artery bypass grafting is one of the routine daily surgical procedures in the current era. Parallel to the increasing life expectancy, cardiac surgery is commonly performed in octogenarians. However, literature consists of only seldom reports of coronary artery bypass grafting in patients above 90 years of age. In this report, we present our management strategy in a 105-year-old patient who underwent coronary artery bypass grafting at our institution.

Predictors and Outcomes of Sternotomy Conversion and Cardiopulmonary Bypass Assistance in Minimally Invasive Coronary Artery Bypass Grafting

2016 ◽  
Vol 11 (5) ◽  
pp. 315-320 ◽  
Author(s):  
Maria L. Rodriguez ◽  
Harry R. Lapierre ◽  
Benjamin Sohmer ◽  
Jean-Philippe Ruel ◽  
Marc A. Ruel
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Objective This work's objective was to identify the determinants of conversion of minimally invasive coronary artery bypass grafting to sternotomy, with and without cardiopulmonary bypass assistance, and to compare clinical outcomes in patients who needed conversion. Methods This is a prospectively collected data on patients who underwent minimally invasive coronary bypass done by a single surgeon from February 2005 to September 2014. Statistical analyses were expressed as mean values ± standard deviation or proportions. Results The total number of patients was 266, with an average age of 62 years. The median number of grafted territories was 2, higher in those with pump assistance (median, 3 grafts; P ≤ 0.01). Predictors for use of cardiopulmonary bypass included diabetes, 3-vessel disease, left circumflex involvement, and small target vessels (P < 0.05). The rate for sternotomy conversion was 3.8%. Risk factors for conversion to sternotomy included smoking, preoperative bradycardia (<50 beats per minute), low intraoperative ejection fraction, inability to tolerate one-lung ventilation, inadequate surgical exposure, and hemodynamic instability. Postoperative complications included superficial thoracotomy infection (3%), sternotomy infection (10%), new atrial fibrillation (3%), and need for blood transfusion (14%). Twelve patients (5%) developed left-sided pleural effusion that required drainage. There were no perioperative deaths, major adverse cardiac event, or stroke. Conclusions Minimally invasive coronary bypass grafting with conversion to sternotomy and use of cardiopulmonary bypass is safe. Conversions may be alleviated by an effort to optimize modifiable risk factors and the adequacy of surgical exposure. These data may help develop objective selection criteria to identify patients who are excellent candidates for the procedure.

scholarly journals Causes affecting the working capacity of patients undergoing coronary bypass surgery (systematic review)

2021 ◽  
Vol 65 (6) ◽  
pp. 581-586
Author(s):  
Maria A. Kuzmichkina ◽  
Viktoria N. Serebryakova
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Coronary Bypass Surgery ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

A review of the available domestic and foreign literary sources is presented concerning factors affecting the working capacity of persons after coronary artery bypass grafting. It was found that in Russia, after surgical treatment of coronary heart disease, there is an increase in the number of disabled people compared to foreign data. In recent years, there has been an increase in patients undergoing coronary bypass surgery. However, this did not reduce the increasing number of disabled people after coronary artery bypass grafting, which does not correspond to the initial expectations about the cost-effectiveness of this type of surgery. According to Russian researchers, the proportion of persons with disabilities referred for surgical myocardial revascularization was 39.0-42.5%. Subsequently, this indicator increased to 64.0%. In other countries, the dynamics are different. Among patients under 60 years of age who underwent surgical treatment of coronary artery disease, more than half returned to work. In general, labour activity was restored by 67.5%, and the number of disabled persons decreased from 56.0 to 42.0%. Social and medical factors were assessed to establish the causes of disability after coronary artery bypass grafting. World experience testifies to the critical role of state social support in preserving the labour status of patients, which ultimately justifies the economic costs of surgical treatment. To assess the degree of disability after coronary artery bypass grafting, social status before surgical treatment of coronary heart disease, and the severity of comorbid pathology. To increase the economic efficiency of coronary bypass surgery, it is necessary to organize an affordable and effective rehabilitation program, uniform criteria for referring patients to medical and social expertise.

scholarly journals Outcomes of coronary artery bypass grafting in patients with high-risk non-ST-segment elevation acute coronary syndrome within the first 24 hours of admission

2020 ◽  
Vol 24 (2) ◽  
pp. 73
Author(s):  
A. B. Nishonov ◽  
R. S. Tarasov ◽  
S. V. Ivanov ◽  
T. S. Golovina ◽  
L. S. Barbarash
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
High Risk ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
St Segment Elevation ◽  
St Segment

<p><strong>Purpose.</strong> The current myocardial re-vascularisation guidelines recommend that the coronary re-vascularisation of patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) should be performed within 24 hours of admission. In real clinical practice; however, it is not always possible to keep coronary bypass surgery on schedule owing to various reasons. The aim of the current study, which presents cases of successful adherence to the surgical schedule, was to explore the need for 24/7 cardiac surgery services and to evaluate the outcomes of early (i.e. during the first 24 hours) coronary artery bypass grafting in 21 patients with high-risk NSTE-ACSs.<br /><strong>Methods.</strong> The medical records of patients undergone coronary bypass surgery for high-risk NSTE-ACSs within the first 24 hours of admission between 2017 and 2019 were retrospectively analysed.<br />Results. The mean age of the patients was 64.3 ± 5.6 years. Myocardial infarction was confirmed in 52.4 % (n = 11) of the subjects and progressive angina pectoris in 47.6 % (n = 10). The average waiting time to surgery was 17.8 ± 4.7 hours. Besides, 9.5 % (n = 2) of the cases, who had received dual antiplatelet therapy, exhibited a shorter waiting time to surgery. Patients were characterised by extremely severe clinical and angiographic status as follows: one in three had post-infarction cardiosclerosis and a first-degree family history of obesity; one in four had a history of percutaneous coronary intervention; and 61.9 % (n = 13) were found to have a left main coronary artery lesion, in 79.6 % (n = 10) of whom the left main coronary artery stenosis appeared to be greater than 80 %, necessitating the intra-aortic balloon counter-pulsation therapy in 33.3 % (n = 7) overall. Also, the mean cardiopulmonary bypass time turned out to be 88.6 ± 27.1 minutes, with an aortic clamping time of 47.6 ± 14.7 minutes. The in-hospital mortality rate was 14.3 % (n = 3), with cardiac and respiratory failure as well as mediastinitis (in one patient) being among the causes of adverse outcomes. So far, none of the studied cases has required re-sternotomy due to bleeding or perioperative acute cerebrovascular accident.<br /><strong>Conclusion.</strong> In high-risk NSTE-ACS patients with severe clinical and angiographic status, emergency coronary bypass surgery performed within 24 hours of admission may prove an effective treatment option that can help save patients’ lives through complete re-vascularisation.<br /><br />Received 31 March 2020. Revised 2 May2020. Accepted 16 May 2020.</p><p><strong>Funding:</strong> The study is supported as a part of the research program "Complete myocardial revascularization in patients with non-ST segment elevation acute coronary syndrome with coronary artery bypass grafting".</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: A.B. Nishonov<br />Data collection and analysis: A.B. Nishonov<br />Drafting the article: A.B. Nishonov, R.S. Tarasov<br />Critical revision of the article: S.V. Ivanov, T.S. Golovina, L.S. Barbarash<br />Final approval of the version to be published: A.B. Nishonov, R.S. Tarasov, S.V. Ivanov, T.S. Golovina, L.S. Barbarash</p>

Perioperative Myocardial Protection with Continuous Infusion of Diltiazem in Coronary Bypass Surgery

1993 ◽  
Vol 1 (4) ◽  
pp. 174-179
Author(s):  
Rainald Seitelberger ◽  
Waltraud Hannes
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Lower Incidence ◽  
Bypass Surgery ◽  
Myocardial Function ◽  
Troponin T ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting

In a randomized study 120 patients undergoing elective coronary artery bypass grafting were investigated to evaluate the perioperative antiischemic and antiarrhythmic efficacy of diltiazem. The patients received a continuous, perioperative infusion of either diltiazem 0.1 mg/kg/h, N = 60) or nitroglycerin (control group lpg/kg/min, N = 60) over a period of 24 hours. Perioperative monitoring included hemodynamic measurements and 3-channel Holter monitoring up to 24 hours postoperatively; repeated assessment of 12–lead electrocardiogram; and analysis of ischenlia-specific laboratory parameters (CK-MB and troponin-T). Myocardial function was assessed preoperatively at 1 and 4 hours after cardiopulmonary bypass by transesophageal echocardiography (TEE, short axis view, monoplane 5 MHz faced array transducer). The 2 groups did not differ with respect to preoperative and operative data. Except for a significant reduction in perioperative heart rate by an average of 9 beats/min, diltiazem had no influence on hemodynamic parameters. The antiischemic efficacy of diltiazem led to a reduction of the number (17 ± 9 vs. 25 ± 5, p < 0.05) and duration (69 ± 47 vs. 104 ± 87 min, p < 0.05) of transient ischemic events and a lower incidence of perioperative myocardial infarction (3.3 vs. 6.7%) as compared to the nitroglycerin group. Peak values of CK-MB and troponin-T were significantly lower in the diltiazem group. Patients treated with diltiazem had a lower incidence of perioperative atrial fibrillation (5 vs. 18%, p < 0.05) and lower numbers of ventricular premature beats/hour (10 ± 8 vs. 19 ± 22, p < 0.05). The postoperative increase in myocardial function was more pronounced in the diltiazem group. The perioperative infusion of diltiazem does not adversely affect perioperative hemodynamics and myocardial contractility but provides potent antiischemic and antiarrhythmic protection of patients undergoing coronary artery bypass grafting. Future investigations must focus on the role of diltiazem in the improvement of long-term prognosis after coronary bypass surgery.

scholarly journals Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Systematic Review of Clinical Outcomes from the Past two Decades

2019 ◽  
Vol 14 (1) ◽  
pp. 5-16 ◽  
Author(s):  
Laszlo Göbölös ◽  
Jehad Ramahi ◽  
Andres Obeso ◽  
Thomas Bartel ◽  
Maurice Hogan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Operative Time ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Conversion Rates

Robotic totally endoscopic coronary artery bypass grafting (TECAB) was introduced in 1998 and has over a period of two decades gradually emerged from single-vessel revascularization to multivessel bypass grafting. Dedicated centers have continuously evolved and further developed this minimally invasive method of coronary bypass surgery. A literature review was conducted to assess intra- and postoperative outcomes of TECAB. PubMed returned 19 comprehensive articles on TECAB. Investigation was focused on perioperative outcome parameters, i.e.: operative time, conversion to larger incision, revision for bleeding, atrial fibrillation, stroke, acute renal failure, and mortality. Outcome from the analysis of 2,397 reported cases showed an average operative time of 291 ± 57 minutes (range 112 to 1,050), conversion rate to larger incisions at 11.5%, and perioperative mortality at 0.8%. Pooled data demonstrated 4.2% operative revision rate due to postoperative hemorrhage, 1.0% stroke incidence, 1.6% acute renal failure, and 13.3% de novo atrial fibrillation. The mean length of hospital stay measured 5.8 ± 1.7 days. Conversion rates and operative times decreased over time. According to data in the literature, coronary bypass surgery carried out in completely endoscopic fashion utilizing robotic assistance can require relatively extensive operative times and conversion rates are somewhat higher than in other robotic cardiac surgery. However, major postoperative events lie in an acceptable range. TECAB remains the surgical revascularization method with the least tissue trauma and represents an opportunity for coronary artery bypass grafting via port access. Rates of major complications are at least similar to conventional surgical access procedures.

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
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