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Vinzant NJ, Christensen JM, Yalamuri SM, Smith MM, Nuttall GA, Arghami A, LeMahieu AM, Schroeder DR, Mauermann WJ, Ritter MJ. Pectoral Fascial Plane Versus Paravertebral Blocks for Minimally Invasive Mitral Valve Surgery Analgesia. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00099-X. [PMID: 36948910 DOI: 10.1053/j.jvca.2023.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/13/2023]
Abstract
OBJECTIVES This study examined the postoperative analgesic efficacy of single-injection pectoral fascial plane (PECS) II blocks compared to paravertebral blocks for elective robotic mitral valve surgery. DESIGN A single-center retrospective study that reported patient and procedural characteristics, postoperative pain scores, and postoperative opioid use for patients undergoing robotic mitral valve surgery. SETTING This investigation was performed at a large quaternary referral center. PARTICIPANTS Adult patients (age ≥18) admitted to the authors' hospital from January 1, 2016, to August 14, 2020, for elective robotic mitral valve repair who received either a paravertebral or PECS II block for postoperative analgesia. INTERVENTIONS Patients received an ultrasound-guided, unilateral paravertebral or PECS II nerve block. MEASUREMENTS AND MAIN RESULTS One hundred twenty-three patients received a PECS II block, and 190 patients received a paravertebral block during the study period. The primary outcome measures were average postoperative pain scores and cumulative opioid use. Secondary outcomes included hospital and intensive care unit lengths of stay, need for reoperation, need for antiemetics, surgical wound infection, and atrial fibrillation incidence. Patients receiving the PECS II block required significantly fewer opioids in the immediate postoperative period than the paravertebral block group, and had comparable postoperative pain scores. No increase in adverse outcomes was noted for either group. CONCLUSIONS The PECS II block is a safe and highly effective option for regional analgesia for robotic mitral valve surgery, with demonstrated efficacy comparable to the paravertebral block.
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Affiliation(s)
- Nathan J Vinzant
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jon M Christensen
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Suraj M Yalamuri
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Mark M Smith
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Gregory A Nuttall
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Allison M LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Darrell R Schroeder
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - William J Mauermann
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Matthew J Ritter
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.
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Alamdar A, Hanife S, Farahmand F, Behzadipour S, Mirbagheri A. A minimally invasive robotic surgery approach to perform totally endoscopic coronary artery bypass on beating hearts. Med Hypotheses 2019; 124:76-83. [PMID: 30798923 DOI: 10.1016/j.mehy.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/11/2018] [Accepted: 02/01/2019] [Indexed: 01/01/2023]
Abstract
The currently available robotic systems rely on rigid heart stabilizers to perform totally endoscopic coronary artery bypass (TECAB) surgery on beating hearts. Although such stabilizers facilitate the anastomosis procedure by immobilizing the heart and holding the surgery site steady, they can cause damage to the heart tissue and rupture of the capillary vessels, due to applying relatively large pressures on the epicardium. In this paper, we propose an advanced robotic approach to perform TECAB on a beating heart with minimal invasiveness. The idea comes from the fact that the main pulsations of the heart occur as excursions in normal direction, i.e., perpendicular to the heart surface. We devise a 1-DOF flexible heart stabilizer which eliminates the lateral movements of the heart, and a 1-DOF compensator mechanism which follows the heart trajectory in the normal direction, thus canceling the relative motion between the surgical tool and the heart surface. In fact, we bring a compromise between two radical approaches of operating on a completely immobilized beating heart with no heart motion compensation, and operating on a freely beating heart with full compensation of heart motion, considering the invasiveness of the first and the technical challenges of the second approach. We propose operating on a partially stabilized beating heart with unidirectional compensation of the heart motion; the flexible stabilizer would exert much less holding force to the heart tissue and the robotic system with unidirectional compensator would be technically feasible. In the proposed approach, a motion sensor mounted on the stabilizer measures the heart excursion data and sends it into a control unit. A predictive controller uses this data to generate an automated trajectory. The slave robots follow this trajectory, which is superimposed on the surgeon's tele-operation commands received from a master console. Finally, the tool-activation units in the slave robots actuate the articulated laparoscopic tools to perform the anastomosis procedure. The evaluation of the hypothesis showed that our solution for the robotic TECAB on beating heart is both practical and cost effective. We showed in an in-vivo study that the flexible stabilizer can effectively restrict the heart lateral movements, while allowing for its normal excursion. We found readily available linear motors which could afford the high forces, speeds and accelerations required for following the heart trajectory. Finally, we showed that the tool-activation unit is capable of providing the maneuverability and workspace required for the most challenging task of CABG procedure, i.e., anastomosis suturing.
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Affiliation(s)
- Alireza Alamdar
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Shahrzad Hanife
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran; Research Center for Biomedical Technologies and Robotics (RCBTR), Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Behzadipour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
| | - Alireza Mirbagheri
- Department of Medical Physics & Biomedical Engineering, School of Medicine, Iran; Research Center for Biomedical Technologies and Robotics (RCBTR), Tehran University of Medical Sciences, Tehran, Iran.
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Xu Y, Li Y, Bao W, Qiu S. MIDCAB versus off-pump CABG: Comparative study. Hellenic J Cardiol 2019; 61:120-124. [PMID: 30685419 DOI: 10.1016/j.hjc.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To investigate the clinical significance of minimally invasive direct coronary artery bypass (MIDCAB). METHODS Three hundred patients admitted to the Second Hospital of Shandong University from March 2006 to February 2010 were retrospectively analyzed and received off-pump operation under general anesthesia. Depending on surgical methods, patients were divided into the MIDCAB group (n = 90) and the median sternotomy off-pump coronary artery bypass (OPCAB) group, named as the OPCAB group (n = 210). Preoperative clinical data, perioperative clinical data, and mid-term follow-up at 7 years after operation were analyzed and compared between the two groups. RESULTS Age and the number of vascular lesions in the OPCAB group were higher than those in the MIDCAB group, whereas left ventricular ejection fraction (LVEF) in the former was lower than that in the latter (p<0.05). The number of distal anastomotic stomas, operation time, blood transfusion volume, postoperative cardiac troponin I (cTnI) peak value, ventilator use time, intensive care unit (ICU) stay, and hospital stay in the MIDCAB group were significantly lower than those in the traditional OPCAB group (p<0.05). Among the 294 recovered cases, 201 cases completed 7 years of continuous follow-up, with a follow-up rate of 67.91%. The LVEF and the patency rate of vessels in the MIDCAB group were higher than those in the OPCAB group (p<0.05). CONCLUSIONS Compared with the median sternotomy OPCAB, MIDCAB is characterized by small incision, small trauma, positive efficacy, and safety; therefore, it is worthy of being promoted.
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Affiliation(s)
- Yunbin Xu
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan 250033, PR China.
| | - Yong Li
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Weiguo Bao
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan 250033, PR China
| | - Shi Qiu
- Department of Cardiovascular Surgery, The Second Hospital of Shandong University, Jinan 250033, PR China
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Moll V, Maffeo C, Mitchell M, Ward CT, Groff RF, Lee SC, Halkos ME, Jabaley CS, O’Reilly-Shah VN. Association of Serratus Anterior Plane Block for Minimally Invasive Direct Coronary Artery Bypass Surgery With Higher Opioid Consumption: A Retrospective Observational Study. J Cardiothorac Vasc Anesth 2018; 32:2570-2577. [DOI: 10.1053/j.jvca.2018.04.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Indexed: 11/11/2022]
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Florisson DS, DeBono JA, Davies RA, Newcomb AE. Does minimally invasive coronary artery bypass improve outcomes compared to off-pump coronary bypass via sternotomy in patients undergoing coronary artery bypass grafting? Interact Cardiovasc Thorac Surg 2018; 27:357-364. [PMID: 29579209 DOI: 10.1093/icvts/ivy071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 02/16/2018] [Indexed: 11/12/2022] Open
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients undergoing off-pump coronary artery bypass grafting, for single or multivessel disease, does minimally invasive direct coronary artery bypass (MIDCAB) or off-pump coronary artery bypass (OPCAB) provide the superior outcome including a reduction in morbidity and mortality?'. A total of 187 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, date, journal and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. It was found that compared to OPCAB, MIDCAB surgery can offer decreased intensive care unit length of stay (4.5-57.4 h vs 5.2-52.7 h) and total hospital length of stay (4.5-8.5 days vs 5.2-12 days), with 1 paper showing a decrease in mortality at 1 year (3% vs 14%). However, there were several papers that showed significant risks with MIDCAB surgery in patients with either single or multivessel disease. These include increased risk of incomplete revascularization (29% vs 0%), significant early complications (22.5 vs 0%), urgent reintervention (16% vs 0%), repeat revascularization events (12.2% vs 3.7%), progression of native disease (4.8% vs 0.9%), rehospitalization by 3 months (20% vs 2%) and postoperative infarction (2.9% vs 1.45%). These risks did not translate to an increase in early mortality (0-1% vs 0-1.6%) or late mortality (0-3% vs 0-14%) in papers that included mid-term follow up. However, they do represent significant potential risks that cannot be overlooked when considering the use of MIDCAB. We conclude that MIDCAB is associated with greater morbidity and reintervention compared to OPCAB via sternotomy, but both techniques are equivalent in terms of operative and mid-term mortality.
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Affiliation(s)
- Daniel S Florisson
- Department of Cardiothoracic Surgery, St Vincent's Public Hospital, Melbourne, VIC, Australia
| | - Joshua A DeBono
- Department of Cardiothoracic Surgery, St Vincent's Public Hospital, Melbourne, VIC, Australia
| | - Reece A Davies
- Department of Cardiothoracic Surgery, St Vincent's Public Hospital, Melbourne, VIC, Australia
| | - Andrew E Newcomb
- Department of Cardiothoracic Surgery, St Vincent's Public Hospital, Melbourne, VIC, Australia
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Perioperative outcomes in minimally invasive direct coronary artery bypass versus off-pump coronary artery bypass with sternotomy. Wideochir Inne Tech Maloinwazyjne 2017; 12:285-290. [PMID: 29062450 PMCID: PMC5649490 DOI: 10.5114/wiitm.2017.67679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/14/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Surgical treatment of isolated left anterior descending coronary artery disease can be performed with either minimally invasive direct coronary artery bypass via a left anterior thoracotomy (MIDCAB) or off-pump coronary artery bypass via a median sternotomy (OPCAB). Aim To compare the perioperative outcomes of patients undergoing MIDCAB or OPCAB surgery. Material and methods Patients who underwent either MIDCAB or OPCAB for isolated left anterior descending (LAD) coronary artery disease between October 2013 and December 2015 were retrospectively evaluated. Operations were carried out by the same surgical team. Preoperative, intraoperative and postoperative data of the patients were recorded for analyses. Results Twenty-three patients (7 females, 16 males) underwent MIDCAB surgery, and 24 patients (4 female, 20 males) underwent OPCAB surgery. The two groups were comparable regarding preoperative patient characteristics. Duration of mechanical ventilation (5.1 ±0.7 h vs. 6.6 ±0.9 h), intensive care unit stay (19.4 ±2.5 h vs. 45.8 ±5.4 h) and hospital stay (4.3 ±0.4 days vs. 5.6 ±0.8 days) were significantly shorter in the MIDCAB group (p < 0.01). Patients in the OPCAB group required significantly more blood transfusions (1.83 ±0.38 units vs. 0.17 ±0.38 units) and fresh frozen plasma use (2.33 ±0.96 units vs. 0.69 ±0.76 units) (p < 0.01). Conversion to sternotomy was not required in the MIDCAB group. There was no mortality, conversion to cardiopulmonary bypass or serious complication in either group. Conclusions We believe that the MIDCAB technique is more advantageous than the OPCAB technique in the treatment of patients with a critical LAD lesion.
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Baishya J, George A, Krishnamoorthy J, Muniraju G, Chakravarthy M. Minimally invasive compared to conventional approach for coronary artery bypass grafting improves outcome. Ann Card Anaesth 2017; 20:57-60. [PMID: 28074797 PMCID: PMC5290697 DOI: 10.4103/0971-9784.197837] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Minimally invasive (MI) cardiac surgery is a rapidly gaining popularity, globally as well as in India. We aimed to compare the outcome of MI to the conventional approach for coronary artery bypass graft (CABG) surgery. METHODS This prospective, comparative study was conducted at a tertiary care cardiac surgical center. All patients who underwent CABG surgery via MI approach (MI group) from July 2015 to December 2015 were enrolled and were compared against same number of EuroSCORE II matched patients undergoing CABG through conventional mid-sternotomy approach (CON group). Demographic, intra- and post-operative variables were collected. RESULTS In MI group, duration of the surgery was significantly longer (P = 0.029). Intraoperative blood loss lesser (P = 0.002), shorter duration of ventilation (P = 0.002), shorter Intensive Care Unit stay (P = 0.004), shorter hospital stay (P = 0.003), lesser postoperative analgesic requirements (P = 0.027), and lower visual analog scale scores on day of surgery (P = 0.032) and 1 st postoperative day (P = 0.025). No significant difference in postoperative blood loss, blood transfusion, or duration of inotrope requirement observed. There was no conversion to mid-sternotomy in any patients, 8% of patients had desaturation intraoperatively. There was no operative mortality. CONCLUSION MI surgery is associated with lesser intraoperative blood loss, better analgesia, and faster recovery.
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Affiliation(s)
- Jitumoni Baishya
- Department of Anesthesiology and Critical care, Fortis Hospital, Bengaluru, Karnataka, India
| | - Antony George
- Department of Anesthesiology and Critical care, Fortis Hospital, Bengaluru, Karnataka, India
| | | | - Geetha Muniraju
- Department of Anesthesiology and Critical care, Fortis Hospital, Bengaluru, Karnataka, India
| | - Murali Chakravarthy
- Department of Anesthesiology and Critical care, Fortis Hospital, Bengaluru, Karnataka, India
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Yang M, Xiao LB, Gao ZS, Zhou JW. Clinical Effect and Prognosis of Off-Pump Minimally Invasive Direct Coronary Artery Bypass. Med Sci Monit 2017; 23:1123-1128. [PMID: 28257412 PMCID: PMC5347985 DOI: 10.12659/msm.902940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Coronary artery bypass grafting (CABG) is a common procedure to circumvent the obstruction of coronary arteries when stents are unsuitable. CABG is a very traumatic surgery that requires redirecting blood flow to an external pump. Thus, this procedure has many risks during and after surgery, and minimizing these risks would greatly benefit the patients. Material/Methods We selected 126 patients with coronary artery syndrome and who were unsuitable for stent percutaneous coronary intervention. The observation group received minimally invasive direct coronary artery bypass (MIDCAB), while the control group was treated with off-pump CABG. Results Blood markers and echocardiography before and after treatment improved equally in both groups. Neither group exhibited obvious adverse reactions, or liver and kidney function damage. However, surgical bleeding and postoperative observation days were significantly reduced in the MIDCAB group. Death and cardiac shock at the end of follow-up were significantly lower in the MIDCAB group. Conclusions Overall, the clinical benefits of MIDCAB and OP-CABG were similar, but MIDCAB significantly reduced postoperative hospital stay and intraoperative blood transfusion, and improved clinical prognosis.
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Affiliation(s)
- Ming Yang
- Department of Cardiothoracic Surgery, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Lian-Bo Xiao
- Department of Cardiothoracic Surgery, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Zhi-Sheng Gao
- Department of Cardiovascular Internal Four, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
| | - Ji-Wu Zhou
- Department of Cardiothoracic Surgery, Cangzhou City Central Hospital, Cangzhou, Hebei, China (mainland)
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Minimally invasive cardiac surgery: A systematic review and meta-analysis. Int J Cardiol 2016; 223:554-560. [PMID: 27557486 DOI: 10.1016/j.ijcard.2016.08.227] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/12/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Minimally invasive (MI) cardiac surgery was introduced to reduce problems associated with a full sternotomy. This meta-analysis aimed to investigate the effects of minimally invasive cardiac surgery on a range of clinical outcomes. METHODS To identify potential studies (randomised/prospective clinical trials) systematic searches were carried out. The search strategy included the concepts of "minimally invasive" OR "MIDCAB" AND "coronary artery bypass grafting" OR "cardiac surgery". This was followed by a meta-analysis investigating cross-clamp time, cardiopulmonary bypass (CPB) time, operation time, ventilation time, intensive care unit (ICU) stay, hospital stay, incidence of myocardial infarction and of stroke/neurologic complications. RESULTS Eight studies (9 intervention groups), totalling 596 participants were analysed. MI cardiac surgery was associated with a shorter ICU stay mean difference (MD) -0.7days (95% confidence interval (CI) -1.23 to -0.18, p=0.009) and longer cross-clamp MD 6.7min (95% CI 1.24 to 12.17, p=0.02), CPB MD 26.68min (95% CI 10.31 to 43.05, p=0.001), and operation times MD 55.03min (95% CI 22.76 to 87.31, p=0.0008). However no differences were found in the ventilation time MD -3.94h (95% CI -8.09 to 0.21, p=0.06), length of hospital stay MD -1.14days (95% CI -3.11 to 0.83, p=0.26) and in the incidence of myocardial infarction odds ratio (OR) 1.97 (95% CI 0.49 to 7.9, p=0.34) or stroke/neurologic complications OR 0.67 (95% CI 0.11 to 4.05, p=0.66). CONCLUSIONS Minimally invasive cardiac surgery is as safe as conventional surgery and could reduce costs due to a shorter period spent in ICU.
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Kayatta MO, Halkos ME. Reviewing hybrid coronary revascularization: challenges, controversies and opportunities. Expert Rev Cardiovasc Ther 2016; 14:821-30. [PMID: 27042753 DOI: 10.1080/14779072.2016.1174576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Two main approaches to myocardial revascularization currently exist, coronary artery bypass and percutaneous coronary intervention. In patients with advanced coronary artery disease, coronary artery bypass surgery is associated with improved long term outcomes while percutaneous coronary intervention is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach. This new approach, hybrid coronary revascularization, has shown encouraging early results. Minimally invasive techniques for bypass surgery have played a large part of bringing this approach into contemporary practice.
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Affiliation(s)
- Michael O Kayatta
- a Division of Cardiothoracic Surgery , Emory University School of Medicine , Atlanta , GA , USA
| | - Michael E Halkos
- a Division of Cardiothoracic Surgery , Emory University School of Medicine , Atlanta , GA , USA
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Birla R, Patel P, Aresu G, Asimakopoulos G. Minimally invasive direct coronary artery bypass versus off-pump coronary surgery through sternotomy. Ann R Coll Surg Engl 2013; 95:481-5. [PMID: 24112493 PMCID: PMC5827271 DOI: 10.1308/003588413x13629960047119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2013] [Indexed: 11/22/2022] Open
Abstract
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.
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Sun TK, Chou HT. Staged Hybrid Revascularization in an Octogenarian Male with Chronic Kidney Disease and Three-vessel Coronary Artery Disease with Left Main Coronary Artery Involvement. INT J GERONTOL 2013. [DOI: 10.1016/j.ijge.2012.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Is Chronic Total Coronary Occlusion a Risk Factor for Long-Term Outcome After Minimally Invasive Bypass Grafting of the Left Anterior Descending Artery? Ann Thorac Surg 2010; 89:1496-501. [DOI: 10.1016/j.athoracsur.2010.01.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 01/21/2010] [Accepted: 01/25/2010] [Indexed: 11/23/2022]
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