Multivessel Arterial Revascularization via Left Anterior Thoracotomy

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

doi:10.1053/j.semtcvs.2020.02.032

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…MIDCAB is one of the novel CABG approaches that enable a minimally invasive approach to coronary revascularization through a left small thoracotomy. The short and midterm clinical outcomes and graft patency are excellent with a short length of hospital stay, less infection of the surgery site, and rapid postoperative recovery [Repossini 2019;Raja 2018;Babliak 2020]. The satisfactory results encouraged us to adopt the technique of MIDCAB in 2012.…”

Section: E778mentioning

confidence: 99%

Simulation Training in Minimally Invasive Direct Coronary Artery Bypass Grafting

Song

Zhao

et al. 2020

HSF

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Background: To evaluate the effect of minimally invasive direct coronary artery bypass (MIDCAB) simulator for cardiac residency training. Methods: A total of 26 resident surgeons who had never trained for coronary artery anastomosis participated in this training program. They received coronary artery anastomosis training on off-pump coronary artery bypass grafting (OPCAB) simulator for 15 h. After training, their performance of anastomosis was evaluated on the OPCAB simulator according to 12 items and a 5-point global rating scale. Based on the total score of assessment, those with an individual score of 12-36 formed group A, while group B was composed of the remaining trainees. The two groups then received another 15 h coronary artery anastomosis training on the MIDCAB simulator, and the performance was assessed. Results: Trainees improved their performance of coronary artery anastomosis after training on the OPCAB simulator. Group A was composed of 7 trainees with an individual with a total score of 12–36 points and group B was composed of the remaining 19 trainees. After MIDCAB simulator training, significant differences were noted in the pre- and post-training values in the A group (P < .001), and the assessment value of group A was significantly better than those of group B (P < .05). No significant difference was detected between pre- and post-training values in group B after MIDCAB simulator training (P > .05). Conclusion: We concluded that trainees who performed well in OPCAB simulation training can also perform better in MIDCAB, and our designed MIDCAB simulator was useful for residency training.

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Section: E778mentioning

confidence: 99%

Simulation Training in Minimally Invasive Direct Coronary Artery Bypass Grafting

Song

Zhao

et al. 2020

HSF

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“…45 Exciting reports of multivessel complete minimally invasive surgical revascularization may provide the full benefits of classic CABG as an alternative treatment strategy for multivessel CAD. 46 In addition to the proposed patient selection criteria for starting RE-MIDCAB programs, univariate analysis identified premorbid renal dysfunction as the only statistically significant contributors to RE-MIDCAB sternotomy conversion in our series. We did not apply scientifically validated measurement tools to statistically calculate the number of cases required to minimize sternotomy conversion or adverse events.…”

Section: Discussionmentioning

confidence: 77%

Reasons for Conversion and Adverse Intraoperative Events in Robotically Enhanced Minimally Invasive Coronary Artery Revascularization

Merwe

Casselman

Vermeulen

et al. 2020

Innovations�(Phila)

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Objective The transition from sternotomy access to minimally invasive coronary artery bypass grafting is associated with steep learning curves. This study reports the reasons for sternotomy conversions from robotically enhanced minimally invasive direct coronary artery bypass grafting (RE-MIDCAB) and describes potential risk reduction strategies. Methods The perioperative data of 759 RE-MIDCAB patients (mean age 65.9 ± 10 years, 25.5% female, 30.2% multivessel disease) operated between July 1, 2002 and November 30, 2018 were reviewed for the reasons of conversion and adverse intraoperative events. Hybrid revascularization was planned in 204 (26.9%) patients. Results Sternotomy conversion occurred in 30 (4.0%) patients. Lung adhesions and unsuccessful single-lung ventilation prohibited safe RE-MIDCAB internal thoracic artery (ITA) harvesting in 11 (36.7%) and 1 (3.3%) patients, respectively. ITA dysfunction ( n = 11, 36.7%) and inadequate target vessel visualization ( n = 3, 10.0%) were among the anatomical reasons for conversions. Adverse intraoperative events included ventricle perforation ( n = 1, 3.3%) and sustained ventricular arrhythmia ( n = 1, 3.3%). The in-hospital mortality and mean length of hospitalization for sternotomy conversion were 3.3% ( n = 1 of 30) and 13.4 ± 14.5 days, respectively. Perioperative morbidities included pneumonia ( n = 4, 13.3%). Premorbid renal dysfunction predicted sternotomy conversion at the 5% level of significance. Conclusions RE-MIDCAB provides an attractive surgical platform for primary- or hybrid coronary artery procedures. The progressive increase in patient risk profiles, strict quality control, and focus on clinical governance require awareness of reasons that potentially contribute RE-MIDCAB to sternotomy conversion to ensure safe and sustainable programs.

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“…The current paradigm shift towards less invasive coronary interventions are paralleled by innovative MISCAR procedural and technological advances that comply with traditional CABG principles, graft patency, clinical outcomes and patient satisfaction (63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80). Various institutions and collaborative reports now describe innovative variations in robotic-and non-robotic MISCAR techniques, with reports that outline risk reduction strategies for safe implementation of MISCAR programs also emerging (115)(116)(117)(118)(119)(120)(121).…”

Section: New Developments In Minimally Invasive Surgical Coronary Art...mentioning

confidence: 99%

“…Investigations that compare MISCAR economics with the total peri-interventional and long-term costs of protected PCI-procedures using expensive assist device support with its associated complications, chronic total occlusion PCI procedures and technology and the utilisation of costly AR technology as part of routine PCI practice, will provide valuable insight into complex PCI and MISCAR healthcare economics. Non-robotic MISCAR approaches as described by Babliak et al (80,126) and Çaynak et al (127) that utilise re-usable retractor systems gained favour in developing countries despite the lack of favourable cost evidence and are rapidly evolving into the preferred MISCAR approaches in countries with economic restraints.…”

Section: A B Cmentioning

confidence: 99%

“…Various innovative MISCAR programs recently reported the extended application of MISCAR to achieve complete surgical coronary revascularization within the context of MVD. Babliak and colleagues (80,126) described their technique of total coronary revascularization through a left mini-thoracotomy and reported their outcomes in 229 consecutive patients with MVD, of which 20.5% underwent total arterial revascularization. Their multi-vessel grafting technique through a 6-8 cm skin incision and 4 th intercostal space anterior mini-thoracotomy includes the use of ITA and /or radial arteries, cardiopulmonary bypass, manoeuvres to optimize the operative field, antegrade cardioplegia delivery and aortic cross-clamping.…”

Section: The Application Of Miscar In Multi-vessel Diseasementioning

confidence: 99%

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Minimally invasive surgical coronary artery revascularization—current status and future perspectives in an era of interventional advances

Merwe¹,

Casselman²

2023

J Vis Surg

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We are currently witnessing rapid advances in coronary artery disease (CAD) diagnostic-and treatment technology, which include exciting developments in the utilisation of artificial intelligence, stem cell and genetic therapy and pharmacological innovation that complement contemporary transcatheter interventions (PCI) and patient preference for less invasive interventions. Progressive expansion of international CAD treatment guidelines with subsequent changes in referral patterns that favour less invasive interventions, increased patient expectations, industry driven marketing and an increasingly aging population with significant procedural risks, continue to re-define the role of conventional coronary artery bypass surgery by sternotomy access (CABG) in the treatment of CAD. However, the undisputed benefits of CABG over PCI in various clinical scenarios were recently re-confirmed and subsequently resulted in renewed interest in the development and application of less invasive surgical revascularization procedures. Reports by experienced minimally invasive surgical coronary artery revascularization (MISCAR) centres suggest shortand long-term outcomes that are comparable with conventional CABG and created an exciting platform for further MISCAR innovation while contributing to the global initiation of exciting upcoming MISCAR programs. This manuscript outlines the feasibility, current status and preliminary data of recent advances in contemporary CAD diagnostic-and therapeutic technology, provides and overview of the contemporary CAD revascularization decision-making evidence and describe the future perspectives of MISCAR in an era of rapid advances in less invasive CAD prevention-, diagnostic-and therapeutic technology. We trust that this overview will contribute to future research and changes in clinical practice.

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Multivessel Arterial Revascularization via Left Anterior Thoracotomy

Cited by 12 publications

References 15 publications

Simulation Training in Minimally Invasive Direct Coronary Artery Bypass Grafting

Simulation Training in Minimally Invasive Direct Coronary Artery Bypass Grafting

Reasons for Conversion and Adverse Intraoperative Events in Robotically Enhanced Minimally Invasive Coronary Artery Revascularization

Minimally invasive surgical coronary artery revascularization—current status and future perspectives in an era of interventional advances

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