Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients)

Barsoum, Emad; Azab, Basem; Shah, Neeraj; Patel, Nileshkumar; Shariff, Masood A.; Lafferty, James; Nabagiez, John P.; McGinn, Joseph T.

doi:10.1093/ejcts/ezu267

Cited by 32 publications

(15 citation statements)

References 24 publications

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“…The overall computed tomography angiographic graft patency was greater than 93% for all grafts and 100% for LITA grafts. 14 Barsoum et al 15 reported that MICS-CABG had a significantly lower 5-year all-cause mortality than sternotomy-CABG among patients 75 years and older (19.7% vs 47.7%).…”

Section: Discussionmentioning

confidence: 99%

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

Ziankou

Ostrovsky

2015

Innovations�(Phila)

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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.

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Section: Discussionmentioning

confidence: 99%

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

Ziankou

Ostrovsky

2015

Innovations�(Phila)

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“…The rate of stroke was numerically higher in our study, but not statistically different after CABG than after PCI with DES. More refined operative techniques including minimally invasive CABG may further reduce the risk of perioperative stroke, enhancing the safety of CABG in older adults …”

Section: Discussionmentioning

confidence: 99%

“…More refined operative techniques including minimally invasive CABG may further reduce the risk of perioperative stroke, enhancing the safety of CABG in older adults. 20 There are a growing number of older adults requiring coronary revascularization across the world. In real-world clinical practice, however, older adults more frequently choose PCI over CABG because of concerns about postoperative morbidities and mortality.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Coronary Artery Bypass Graft Surgery Versus Drug‐Eluting Stents in Older Adults

Chang

Lee

Ahn

et al. 2017

J American Geriatrics Society

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“…Excellent outcomes of MICS CABG have been reported. 2,3 However, cardiopulmonary bypass is required in some cases of MICS CABG, partly owing to the difficulty of completing the distal anastomosis. We believe our techniques are noteworthy because they allowed successful completion of off-pump MICS CABG in all cases, as intended, with our heart displacement technique.…”

Section: Discussionmentioning

confidence: 99%

Assistive Techniques for Proximal Anastomosis in Minimally Invasive Coronary Artery Bypass Grafting

Kikuchi

Endo

2017

Innovations�(Phila)

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We introduce assistive techniques for proximal anastomosis in off-pump minimally invasive coronary artery bypass grafting (MICS CABG) to overcome difficult access to the ascending aorta in MICS CABG. An 8-cm left thoracotomy is made in the fifth intercostal space. ThoraTrak retractor (Medtronic Inc, Minneapolis, MN USA) is used to open the thoracotomy and is pulled to the cephalad and rightward direction toward to the ascending aorta. The pericardium is opened from the ascending aorta to the left ventricular apex and to the inferior vena cava. Two retraction sutures on the pericardial edge are used to laterally displace the heart. After dissecting between the ascending aorta and main pulmonary artery, the Octopus tissue stabilizer (Medtronic Inc, Minneapolis, MN USA), of which the suction tip is bent 60 degrees, is used to retract the pulmonary artery caudally. A flexible side-biting clamp (Vitalitec Inc.) is placed on the ascending aorta, and proximal anastomoses are handsewn on the ascending aorta. A total of 31 proximal anastomoses were completed with this technique between November 2013 and June 2015. All proximal anastomosis was completed without any difficulty. In MICS CABG, the technical challenges in proximal anastomosis due to difficult access to the aorta can be overcome safely by using this technique.

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Long-term mortality in minimally invasive compared with sternotomy coronary artery bypass surgery in the geriatric population (75 years and older patients)

Cited by 32 publications

References 24 publications

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

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

Outcomes of Coronary Artery Bypass Graft Surgery Versus Drug‐Eluting Stents in Older Adults

Assistive Techniques for Proximal Anastomosis in Minimally Invasive Coronary Artery Bypass Grafting

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