Minimally invasive cardiac surgery-coronary artery bypass graft

Effectiveness of Preventive Measures in the Inactive Course of Chronic Parenchymatic Mumps in Children

Aim: To study the effectiveness of preventive measures in the inactive course of chronic parenchymal mumps in remission. Materials and Methods: In the dynamics of precautionary measures, aimed at preventing of exacerbation of chronic processes in the parotid glands, were examined 29 children aged from 2 months to 16 years with inactive mumps in remission and 10 control persons aged from 7 to 15 years. Results: According to the assessment of the cellular composition of parotid secretion before anti-relapse measures in 9 patients out of 19, it was possible to detect the presence of latent chronic inflammation in symmetrical glands in the absence of classical clinical symptoms and clear secretion. After the completion of the treatment-and-prophylactic complex, the number of inflammatory cells and the degree of its contamination with microorganisms decreased significantly. Conclusions: The study of the composition of parotid secretion with taking into account of the results of ultrasound examination and sialography in the dynamic monitoring of chronic parenchymal mumps indicate its high diagnostic informativeness and allows a rational approach to planning preventive measures. The methodological approach, which was developed and tested by us and which was used in the active course of mumps, showed its high efficiency and inactive form of the disease, for the first year of observation the number of exacerbations decreased by 10 times, and for 5 years term- by 16 times, which allowed to prolong the remission period and improve the rheological properties of parotid secretion.

Comprehensive Rehabilitation of Cardiac Surgery Patients with Acute Left Ventricular Failure who Underwent Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

Aim: To develop and implement a comprehensive rehabilitation of cardiosurgical patients with acute left ventricular failure who underwent on-pump coronary artery bypass grafting. Materials and Methods: 500 patients underwent on-pump coronary artery bypass grafting. Sixty patients who required inotropic support in the postoperative period were selected. The patients were divided into two groups of 30 people each. In both groups, psychological and physical rehabilitation was carried out in accordance with the algorithm developed by us. The protocol EACTS, 2017 for the main group was supplemented with a metabolic support component, the introduction of a combination of levocarnitine and arginine. Results: Psychological and physical algorithm was developed and implemented. In the basic group, the recovery time of hemodynamics and the total dose of the inotropic drug were shorter/lower than in the control one. Conclusions: Stressful moments informing the patient in the perioperative period is a powerful tool for psychological rehabilitation. Aerobic training and respiratory physiotherapy are mandatory elements of physical rehabilitation. The introduction of a combination of levocarnitine and arginine has a positive effect on the terms of activation of patients, and reduces the stay in the intensive care unit.

How to recycle a misused left internal thoracic artery: Tips and tricks

In this case report, we describe how to recycle the left internal thoracic artery (LITA) when misused but not damaged. Eight years after a left anterior small thoracotomy followed by left anterior descending (LAD) stenting for STEMI in first postoperative day, a 67-years-old woman had an NSTEMI with angiographic evidence of intrastent re-stenosis with a perfectly patent LITA, harvested only from the fourth to the sixth intercostal space. During redo surgery, LITA was harvested as a pedicle from the anastomosis to the fourth intercostal space and primarily from the first to the fourth intercostal space. Special attention was paid at the level of the fourth intercostal space where the vessel was stuck to the sternum: a 15-blade was used being scissors or cautery too dangerous. At the end of harvesting, the LITA was full-length available for a new coronary anastomosis on LAD, distal to the previous one.

MICS CABG: a single-center experience of the first 100 cases

PURPOSE

To study the learning curve and outcomes of the first 100 cases of minimally invasive cardiac surgery (MICS) coronary artery bypass grafting (CABG) performed at our center.

METHODS

From January 2017 to November 2019, a total of 100 patients underwent CABG via left anterior thoracotomy approach. We have studied the operative times within the MICS CABG patients to analyze our learning curve. We also studied the postoperative outcomes and compared these with those of patients who underwent sternotomy during the same period.

RESULTS

The mean age was 59.33 ± 9.95 (range 37-82) years. The numbers of males and females were 72 and 28 respectively. The preoperative average ejection fraction (EF) was 51.08 ± 9.75%. All these patients underwent CABG via left thoracotomy approach, after satisfying the exclusion criteria. All patients received left internal mammary artery (LIMA) to left anterior descending (LAD) as a standard graft, with the radial artery and saphenous vein being the next alternative conduits. The average length of the incision was 6.06 ± 0.45 cm. Only 2 cases were done on pump. The average number of grafts per patient was 2.33 ± 0.92. The mean operative time was 132.40 ± 11.56 min. The mean duration of ventilation was 4.79 ± 1.90 h and average intensive care unit (ICU) stay was 2.62 ± 0.84 days. There was one conversion and no mortalities in our study. We had analyzed our operative times and noticed a significant reduction after the first 20 cases, which was our learning curve.

CONCLUSION

MICS CABG can be performed for multivessel disease with the same comfort as for a single or a double vessel disease, once the learning curve has been achieved. Only significant difference from the sternotomy approach was noted in the longer operative times for MICS CABG during the learning curve, and not thereafter. Significant benefits of MICS over sternotomy were noticed in the immediate postoperative parameters like duration of ventilation, mean drainage, postoperative pain, ICU stay, and hospital stay, with no difference in postoperative adverse events.

Cardiac surgery using a single thoracic port-current status and future directions

Cardiac surgery is almost universally performed through a median sternotomy, an approach which is painful, unestethical, and prone to life-threatening infections. Minimally invasive cardiac surgery has tried to avoid problems associated with full sternotomy for many years. Recently, uniportal thoracic surgery was shown to be very advantageous when compared to standard thoracotomy and classical video assisted thoracic surgery (VATS). Despite very good results in lung surgery, cardiac surgery through a single thoracic port has rarely been attempted and successfully conducted. The authors present the rational, the technique, and their experience in cardiac single thoracic port surgery (CSTPS).

Early and Midterm Results of No-Touch Aorta Multivessel Small Thoracotomy Coronary Artery Bypass Grafting: A Propensity Score-Matched Study

Objective

To carry out the comparative analysis of early and midterm results of no-touch aorta multivessel small thoracotomy coronary artery bypass grafting (MVST CABG), conventional off-pump (OPCABG) and on-pump CABG (ONCABG).

Methods

From 2007 to 2014, 537 consecutive patients underwent CABG by the same surgeon. Propensity score computer matching was performed, and a total of 453 patients were successfully matched in 3 groups of 151 patients.

Results

Significant differences were found in the intraoperative blood loss: 220 (180; 300) mL in MVST CABG versus 400 (300; 550) mL in OPCABG vs 350 (250; 435) mL in ONCABG group; first 24-hour postoperative blood loss: 170 (100; 280), 320 (200; 470), and 380 (200; 500)mL, respectively; operation time: 352.4 ± 74.4,289.3 ± 55.0, and 280.4 ± 56.4 minutes, respectively; median time to return to full physical activity: 14, 56, and 56 days, respectively (P < 0.05); rate of deep wound infection: 0.0%, 2.0%, and 2.0%, respectively; and postoperative length of stay (surgical department): 4.5, 7.0, and 7.5 days, respectively (P < 0.1). No significant differences were observed in rates of severe in-hospital events (P > 0.05), cumulative midterm survival, and freedom from major adverse cardiac and cerebrovascular events (P > 0.05).

Conclusions

The MVST CABG seems as safe as OPCABG and ONCABG and is associated with less wound infections, perioperative blood loss, shorter hospital length of stay and time to return to full physical activity. Multivessel small thoracotomy CABG can be applied to most patients with coronary heart disease saving the effectiveness during midterm follow-up. The MVST CABG can be introduced avoiding a prolonged learning curve.

Robotically assisted coronary artery bypass grafting: a systematic review and meta-analysis

BACKGROUND

It remains uncertain as to whether robotically assisted coronary bypass surgery (RACBS) is superior to non-robotic procedures.

METHODS

Literature searches were conducted using MEDLINE, EMBASE and LILACS. Two review authors independently screened citations, assessed trial quality and performed data extraction.

RESULTS

Three trials met the inclusion criteria. None was randomized. Compared with non-robotic approaches, RACBS was associated with longer surgical times, shorter intensive care unit and hospital stays, higher extubation rates and lower odds for atrial fibrillation as well as myocardial infarction. There were no differences for the odds of stroke and mortality between the interventions.

CONCLUSIONS

Although robotic-assisted coronary bypass appears to be promising, the study designs were not adequate and may have a high risk of selection bias. There is a need for randomized trials to corroborate the findings and to determine the long-term benefits of RACBS compared with traditional surgical approaches.