Morbidity, cost, and six-month outcome of minimally invasive direct coronary artery bypass grafting

Magovern, James A.; Benckart, Daniel H.; Landreneau, Rodney J.; Sakert, Tamara; Magovern, George J.

doi:10.1016/s0003-4975(98)00808-x

Cited by 51 publications

(31 citation statements)

References 17 publications

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“…12 Also, in case of single-vessel disease, access to the heart can be obtained via a limited thoracotomy, which may reduce recovery time, hospital stay, and costs. 13 Thus, off-pump bypass surgery may be an alternative for patients in whom stenting is considered the first-choice treatment. Better long-term clinical outcome may offset the still more invasive nature of off-pump surgery.…”

mentioning

confidence: 99%

Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Eefting¹,

Nathoe²,

Dijk³

et al. 2003

Circulation

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Background-Stenting improves cardiac outcome in comparison with balloon angioplasty. Compared with conventional surgery, off-pump bypass surgery on the beating heart without cardiopulmonary bypass may reduce morbidity, hospital stay, and costs. The purpose, therefore, was to compare cardiac outcome, quality of life, and cost-effectiveness 1 year after stenting and after off-pump surgery. Methods and Results-Patients referred for angioplasty (nϭ280) were randomly assigned to stenting (nϭ138) or off-pump bypass surgery. At 1 year, survival free from stroke, myocardial infarction, and repeat revascularization was 85.5% after stenting and 91.5% after off-pump surgery (relative risk, 0.93; 95% CI, 0.86 to 1.02). Freedom from angina was 78.3% after stenting and 87.0% after off-pump surgery (Pϭ0.06). Quality-adjusted lifetime was 0.82 year after stenting and 0.79 year after off-pump surgery (Pϭ0.09). Hospital stay after the initial procedure was 1.43 and 5.77 days, respectively (PϽ0.01). Stenting reduced overall costs by $2933 (26.2%) per patient ($8276 versus $11 209; PϽ0.01). Stenting was more cost-effective in 95% of the bootstrap estimates. Conclusions-At 1 year, stenting was more cost-effective than off-pump surgery while maintaining comparable cardiac outcome and quality of life. Stenting rather than off-pump surgery, therefore, can be recommended as a first-choice revascularization strategy in selected patients.

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mentioning

confidence: 99%

Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Eefting¹,

Nathoe²,

Dijk³

et al. 2003

Circulation

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“…In particular, LITA-LAD bypass via the LAST approach has gained popularity, with a good patency rate, low operative mortality and freedom from angina and cardiac events. 6,7,9,[14][15][16]21,36 Its small skin incision and elimination of CPB and median sternotomy have especially benefi ted patients with a single LAD lesion. A shorter operation time, ICU stay and hospital stay, and lower cost can be achieved by selecting MIDCAB via the LAST approach.…”

Section: Discussionmentioning

confidence: 99%

“…Temporary coronary occlusion is also used during anastomosis to obtain a bloodless fi eld. 36 However, the possibility of tight occlusion of a coronary artery and myocardial ischemia, which could lead to a new stenosis, ventricular arrhythmia or left ventricular dysfunction, are always concerns. Cremer et al reported fi nding a new stenosis of the LAD proximal to the anastomosis and distal to the anastomosis in 16 and 17 of 205 patients, respectively.…”

Section: Intracoronary Shuntmentioning

confidence: 99%

Coronary artery bypass grafting without full sternotomy

Sasaki

2009

Surg Today

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Coronary artery bypass grafting is performed without full sternotomy in selected patients because it is less invasive. Left internal thoracic artery-left anterior descending artery bypass (LITA-LAD bypass) via a small left anterior thoracotomy is a well established procedure, which achieves good graft patency with low mortality and morbidity rates. Multiple revascularization is possible with a limited lateral thoracotomy or L-figure approach. Axillary-coronary bypass and right gastroepiploic artery-right coronary artery bypass (RGEA-RCA bypass) are alternative methods, especially for redo surgery, in selected patients.

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“…Another optional treatment of both disorders may be the combination of minimally invasive cardiac surgery and laparoscopic cholecystectomy. [18][19][20][21] Bacher et al 22 reported that an excessive intraoperative PaCO 2 increase could be prevented by modification of the ventilation procedure and that laparoscopic cholecystectomy was an advantageous technique in the patient with cardiopulmonary disease. In the very near future, this combination may become the standard treatment for these patients.…”

Section: Discussionmentioning

confidence: 99%

Management of cholelithiasis in combination with cardiovascular surgery

et al. 2000

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A retrospective review of the perioperative management of patients with cardiovascular surgical disorders and cholelithiasis was conducted, and the surgical strategies employed are discussed. Between 1988 and 1998, 18 patients having cardiovascular surgical disorders underwent cholecystectomy. These patients were divided into three groups: group I, given a one-stage operation (n = 9); group II, given a two-stage operation (n = 3); and group III, given cholecystectomy during follow-up after cardiovascular surgery (n = 6). In group I, a median laparotomy was adopted for patients with an abdominal aortic aneurysm (AAA) to allow both disorders to be treated through the same incision, whereas a right subcostal approach was employed to separate the incisions for patients who underwent cardiac operations. In group II, one patient underwent cholecystectomy before cardiac surgery, and two patients underwent cholecystectomy for postoperative cholecystitis after cardiovascular operations. One patient from group II and all from group III were on preoperative anticoagulant therapy, two of whom underwent laparoscopic cholecystectomy. No fatal complications such as prosthetic infection, intraperitoneal hemorrhage, or cerebral attack were encountered. In conclusion, we consider that performing cholecystectomy during AAA repair may be safe and prevents the risk of postoperative cholecystitis; it is preferable to treat cholelithiasis coexisting with cardiac disorders concomitantly with or before cardiac operations; and laparoscopic cholecystectomy can be safely performed under anticoagulant therapy.

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Morbidity, cost, and six-month outcome of minimally invasive direct coronary artery bypass grafting

Cited by 51 publications

References 17 publications

Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Coronary artery bypass grafting without full sternotomy

Management of cholelithiasis in combination with cardiovascular surgery

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