Sign in Register now

Minimally Invasive Multivessel CABG: a Modern Option to OPCAB Surgery


  • #AC/COR 02-O-9
  • Adult Cardiac Surgery/Coronary. SESSION-2
  • Oral

Minimally Invasive Multivessel CABG: a Modern Option to OPCAB Surgery

Mikhail Snegirev 1, Artem Paivin 1, Dmitry Denisyuk 1, Nikolai Khvan 1, Lana Sichinava 1, Vladimir Sharafutdinov 2, Andranik Tatoyan 1, Oleg Paivin 2

1 City hospital 40, Saint-Petersburg, Russia; 2 Sokolov hospital of FMBA Russia, Saint-Petersburg, Russia;

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–A

Abstract

Objective

Minimally invasive CABG (MICS-CABG) is a multivessel myocardial revascularization procedure performed via left-side minithoracotomy. Growing interest to MICS-CABG arises on current safety and reproducibility evidence and promising long-term data. We report our initial MICS-CABG experience performed via off-pump approach.

Methods

Since august 2014 204 patients underwent MICS-CABG through 8-10 cm 4-5 intercostal space left-side minithoracotomy. LIMA graft was harvested in routine MIDCAB fashion, saphenous vein was harvested endoscopically, and proximal anastomoses were performed with aortic side-clamp and long-shaft instruments. Distals were performed with routine OPCAB vacuum stabilizers, placed through the wound orifice, and full revascularization was achieved in all cases. Perioperative data was collected, and 3-year results are upcoming.

Results

Mean patient age was 63.9+9.3 years. Most patients were men (61.8%). Mean left ventricle EF was normal (50.7+7.3%). 17.6% had left main stenosis and 26.5% had diabetes mellitus (DM). There was no perioperative mortality. Almost all procedures were performed via off-pump approach (1 case (0.5%) with femoral CPB). Mean number of grafts performed was 2.6±0.9 with median (51.5%) of 3 grafts. In 2 cases (1.0%) conversion to sternotomy and CPB was done due to hemodynamic instability. Mean operative time was 201.5+33.5 min and mean drainage loss was 196.3+88.4 ml. Major postoperative bleeding, requiring reopening was in 1.5% of cases and rate for both MI type V and stroke was 0.5%. In 8 cases (3.9%) wound infection requiring specific treatment was noted.

Conclusion

Familiarizing with conventional OPCAB surgery is a critical step to traverse MICS-CABG learning curve. One should not consider MICS-CABG a substitute to conventional OPCAB, but a likely tool to simplify selection in some categories of high risk patients. Promoting wider acceptance to OPCAB may support current trend to minimize surgical trauma, thus extending availability for CABG.


To top