Background Minithoracotomy avoids the complications specific to sternotomy access, which in turn creates the conditions for early activation and rehabilitation of patients, especially elderly, with diabetes mellitus, obesity, disorders of the musculo-skeletal system. Purpose To assess the patency of grafts after minimally invasive coronary artery bypass grafting (MICS CABG). Methods We analyzed the results of 50 MSCT- angiography made to patients with MICS CABG operated between 2014 and 2016 (28,5±13,5 months after surgery). Totally 132 conduits were used, 47 (35.6%) of them – arterial, 85 (64.4%) – venous. In all cases left internal mammary artery (LIMA) was used for revascularization of the left anterior descending artery (LAD). The great saphenous vein was used as a conduit for revascularization of: diagonal branch (DA) – 10 (11.7%) cases, left circumflex artery (LCx) – 44 (51.8%), right coronary artery (RCA) – 12 (14.1%), posterior interventricular branch – 19 (22.4%). Assessment of the patency of grafts were performed: 1–2 years (33 conduits: 13 arterial, 20 venous), after 2–3 years (51 conduits: 19 arterial, 32 venous) and after 3–4 years (48 conduits: 15 arterial, 33 venous). Results Assessment of coronary grafts patency in the first period revealed occlusion of 3 (15%) venous conduits. In 2 cases, the venous conduit was anastomosed with the LCx, in 1 case with the RCA. The cumulative patency of the grafts was as follows: arterial – 100%, venous – 85%. In the second point of the study occlusion and stenotic changes of LIMA has not been revealed. Determined occlusion 5 (15,6%) venous grafts. In all cases, the occluded venous conduits revascularized the RCA. Total permeability of conduits: arterial – 100%, venous-84.4%. In the third time interval it was revealed: in 1 case of LIMA occlusion and 7 venous grafts, in 4 cases in the area of the LCx, in 2 – DA and in 1 case – in the area of the RCA. Total patency of grafts: arterial – 93.3%, venous – 78.8%. Total permeability of conduits: arterial – 97.9%, venous – 82.4%. Conclusion The analysis shows good long–term results of the functioning of grafts after MICS CABG and their comparability with the results of patency of the conduits after CABG performed by the traditional Funding Acknowledgement Type of funding source: None
Interventional and hybrid methods of treatment, combining open surgical and endovascular repairs, are the most promising areas in the surgery of the thoracoabdominal aorta. Recent studies, however, have demonstrated that complex thoracic endovascular aneurysm repair (TEVAR) is one of the most high-dose endovascular interventions. In addition, TEVAR is associated with the use of a significant volume of contrast media (CM), which can lead to contrast-induced acute kidney injury (CI-AKI). The use of advanced imaging techniques and computed tomographic fusion (CT-fusion) in routine practice can potentially reduce operation duration, radiation exposure and CM volume usage. We analyzed the literature on CTfusion in endovascular aortic repair and present a clinical case of a 50-year-old male with a history of concomitant blunt chest trauma. CT of the chest revealed an aneurysm of the arch and descending aorta after traumatic dissection of the aorta (IIIa DeBakey, type B Stanford), post-traumatic diaphragmatic hernia of the left dome of the diaphragm with stomach and intestinal loops prolapse. The patient underwent a staged hybrid intervention — subtotal aortic arch debranching followed by CT-fusion-guided semi-arch TEVAR. CT-fusion is a dynamically developing technology, may reduce the CM volume, the duration of the procedure and radiation exposure and requires further research.
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