Complete Coronary Revascularization via Left Anterior Thoracotomy

Babliak, Oleksandr; Demianenko, Volodymyr; Melnyk, Yevhenii; Revenko, Katerina; Pidgayna, Liliya; Stohov, Oleksii

doi:10.1177/1556984519849126

Cited by 33 publications

(45 citation statements)

References 12 publications

(23 reference statements)

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“…Table 3 lists the results of the on pump and cardioplegia versions of minimally invasive CABG (46)(47)(48)(49)(50)(51). Eight hundred and ninety-six cases are published in the current literature.…”

Section: Resultsmentioning

confidence: 99%

“…Babliak and coworkers from Kiew recently published their method in which a transthoracic Chitwood clamp is inserted instead. All anastomoses are carried out under direct vision through the minithoracotomy (47). As shown by the Kiew group special slings can be placed around the pulmonary veins and also around the inferior vena cava for exposure of the lateral and back wall of the heart.…”

Section: Surgical Techniquementioning

confidence: 99%

“…In addition, enabling technology for beating heart coronary bypass surgery through minithoracotomy developed well and MIDCAB or MICS-CABG became the preferred method by many less invasive surgeons. The activities of Babliak and co-workers (47) have caught recent attention and it can be expected that due to his excellent results some groups will take over the method. The endoballoon technology has also undergone several improvement steps and has become routine at a considerable number of centers.…”

Section: Commentmentioning

confidence: 99%

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Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

Bonatti¹,

Wallner²,

Crailsheim³

et al. 2021

J Thorac Dis

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During the mid-1990s cardiac surgery started exploring minimally invasive methods for coronary artery bypass grafting (CABG) and has over a 25-year period developed highly differentiated and less traumatic operations. Instead of the traditional sternotomy mini-incisions on the chest or ports are placed, surgery on the beating heart is applied, sophisticated remote access heart lung machine systems as well as videoscopic units are available, and robotic technology enables completely endoscopic approaches. This review describes these methods, reports on the cumulative intra-and postoperative outcome of these procedures, and gives an integrated view on what less invasive coronary bypass surgery can achieve. A total of 74 patient series published on the topic between 1996 and 2019 were reviewed. Six main versions of minimal access and robotically assisted CABG were applied in 11,135 patients. On average 1.3±0.6 grafts were placed and the operative time was 3 hours 42 min ± 1 hour 15 min. The procedures were carried out with a hospital mortality of 1.0% and a stroke rate of 0.6%. The revision rate for bleeding was 2.5% and a renal failure rate of 0.9% was noted. Wound infections occurred at a rate of 1.2% and postoperative hospital stay was 5.6±2.2 days. It can be concluded that less invasive and robotically assisted versions of coronary bypass grafting are carried out with an adequate safety level while surgical trauma is significantly reduced.

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Section: Resultsmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

Bonatti¹,

Wallner²,

Crailsheim³

et al. 2021

J Thorac Dis

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“…Багатосудинне аорто-коронарне шунтування в умовах лівої передньої мініторакотомії за методикою TCRAT (Total Coronary Revascularization via Left Anterior Thoracotomy) [17][18][19] рутинно проводиться в нашій установі, починаючи з липня 2017 року. Зазначена методика застосовується у всіх пацієнтів незалежно від кількості анастомозів, якості та розташування коронарних артерій, індексу маси тіла, віку, наявності супутніх захворювань, прогнозованого післяопераційного ризику.…”

Section: вступunclassified

The Influence of Risk Factors on Perioperative Results of Multivessel Coronary Artery Bypass Grafting Through the Left Anterior Minitoracotomy

Babliak

Demianenko

Babliak

et al. 2021

Transplant. artif. organs

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Multivessel coronary artery bypass grafting (CABG) through the left anterior minitoracotomy using the technique of total coronary revascularization via left anterior thoracotomy (TCRAT) is routinely performed in our institution since July 2017. This technique is used in all patients regardless of the number of anastomoses, quality and location of coronary targets, body mass index, age, comorbidities and predicted postoperative risk. The aim. To present the results of 349 consecutive patients with isolated multivessel coronary artery disease who underwent minimally invasive CABG. To compare perioperative outcomes of minimally invasive CABG in patients with existent risk factors for CABG and to identify possible contraindications to the use of this CABG technique. Materials and methods. From July 2017 to January 2020, 357 consecutive patients were underwent multivessel CABG at our institution. Eight (2.3%) patients in whom CABG was performed through the median sternotomy were excluded from the study. The remaining 349 (97.7%) patients underwent complete myocardial revascularization through the left anterior minitracotomy using TCRAT technique (peripheral cannulation for cardiopulmonary bypass (CPB), cold blood cardioplegia). All the patients were divided into groups according to the presence of risk factors (obesity, old age, diabetes, risk of postoperative mortality greater than 2.0 calculated by EuroSCORE II scale) to analyze the impact of these factors on intraoperative and postoperative parameters. Results. Intra- and postoperative parameters in patients of all groups were within safe limits. There was no statistically significant difference between the patients older and younger than 70. Diabetic and obese patients had a longer total operation time (on average by 5%, p = 0.003 and 7%, p = 0.019, respectively), CPB time (on average by 8%, p = 0.002 and 11%, p = 0.0001, respectively) and intensive care unit stay (on average by 15%, p = 0.004 and 17%, p = 0.013, respectively) compared to the patients without these conditions. The patients with EuroSCORE II risk more than 2.0 were had longer main phase of the operation (on average by 12 minutes, i.e. 8%, p = 0.013), they required longer ventilation time (by 27%, p = 0.036), longer stay in the intensive care unit (by 23%, p = 0.0004), had a longer hospital stay (by 15%, p < 0.0001), they were more likely to have acute kidney damage that required hemodialysis, and mortality was observed only in this group of patients. However, even in this group of severe patients, the incidence of complications and mortality did not exceed the predicted rates. Conclusions. The technique of minimally invasive CABG through the left anterior thoracotomy allow the possibility to avoid median sternotomy in 97.7% of patients with multivessel coronary artery disease. The technique of minimally invasive multivessel CABG through the left anterior thoracotomy is universal and does not require patient selection, because it can be used effectively and safely regardless of obesity, diabetes or old age. This technique can be performed in patients with any EuroSCORE II rate without the mortality rate increase.

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“…Over decades median sternotomy has a been a gold standard approach for treatment of isolated multivessel coronary artery disease but this traditional approach has been associated with sternal wound healing complications leading to remarkable morbidity and mortality. However nowadays various minimal invasive techniques have been described as alternative methods for treatment of coronary lesions (1)(2)(3). Due to difficulty of these procedures and long learning curve,hybrid approach have been also described (4,5).…”

Section: Introductionmentioning

confidence: 99%

Minimal Invasive Multivessel Coronary Artery Revascularization Through Left Anterior Minithoracotomy: A Promising Future

Kyaruzi

Çaynak

2020

Preprint

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Backgrounds Over decades median sternotomy has a been a gold standard approach for treatment of isolated multivessel coronary artery disease but this traditional approach has been associated with sternal wound healing complications leading to remarkable morbidity and mortality. Our aim was to describe our technique of left anterior minithoracotomy through fourth intercostal space for treatment of patients with multivessel coronary lesions . Methods Our experience includes 62 consecutive patients who were operated with the same surgical team. Left internal thoracic artery was harvested in all patients by the aid of rib retractor. All patients were operated under cardiopulmonary bypass (CPB) with blood cardioplegia through left minianterior thoracotomy of 5cm-7cm. All saphenous vein grafts were harvested endoscopically. Results We had no mortality, no early postoperative myocardial infarction was observed . Only one patient was converted to sternotomy(1.6 %). Two patients had postoperative atrial fiblillation(3.2%), 1 patient suffered postoperative stroke(resolved without neurologic deficit)(1.6%), 4 patients had revision due to postoperative bleeding(6.4%) perfomed through the same incision(no sternotomy was required). The mean number of bypass was 3.6 ±0.8, cross clamping time was 95.7 ± 41.0 minutes, cardiopulmonary bypass time was 159.2 ± 46.5 minutes,entubation time was 6.7± 1.9 hours, intensive care unit(ICU) stay was 1.2± 0.6 days, hospital stay was 5.3± 2.7 days. Conclusion CABG via left anterior thoracotomy is equally effective as traditional sternotomy but less invasive,quick recovery and is so promising in terms of less morbidity and mortality. It might be an alternative to sternotomy incision and percutaneous techniques

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Complete Coronary Revascularization via Left Anterior Thoracotomy

Cited by 33 publications

References 12 publications

Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

Minimally invasive and robotic coronary artery bypass grafting—a 25-year review

The Influence of Risk Factors on Perioperative Results of Multivessel Coronary Artery Bypass Grafting Through the Left Anterior Minitoracotomy

Minimal Invasive Multivessel Coronary Artery Revascularization Through Left Anterior Minithoracotomy: A Promising Future

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