Reoperative coronary artery bypass grafting without cardiopulmonary bypass

Fanning, William J.; Kakos, Gerard S.; Williams, Thomas E.

doi:10.1016/0003-4975(93)91025-i

Cited by 98 publications

(21 citation statements)

References 14 publications

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“…If combined LC and HD surgery, performed under CPB, concerns valvular repair or replacement, then after cardiac operation but before LC resection, the pericardium should be surgically closed to avoid dissemination either of neoplastic cells or infectious micro-organisms of respiratory system origin (13). The disadvantage of the off-pump technique is the incomplete revascularization when the coronary obstruction is anatomically positioned in circumflex ramifications (69,70), necessitating a surgical approach using left thoracotomy (69,71). The prerequisites for success of CABG with the off- (72); (III) surgical plan is sufficient for right lung tumors (74); (IV) feasibility of safe intra-operative examination, before establishment of CPB, for detection of possible lymph nodes metastases not preoperatively diagnosed (5); and (V) the possibility of performing mediastinal lymphadenectomy except for subcarinal nodes (74).…”

Section: Discussionmentioning

confidence: 99%

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

Bablekos¹,

Analitis²,

Michaelides³

et al. 2016

Ann. Transl. Med.

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Background: Co-morbidity of primary lung cancer (LC) and heart disease (HD), both requiring surgical therapy, characterizes a high risk group of patients necessitating prompt diagnosis and treatment. The aim of this study is the review of available evidence guiding the management of these patients.Methods: Postoperative outcome of patients operated for primary LC (first meta-analysis) and for both primary LC and HD co-morbidity (second meta-analysis), were studied. Parameters examined in both meta-analyses were thirty-day postoperative mortality, postoperative complications, three-and five-year survival probabilities. The last 36 years were reviewed by using the PubMed data base. Thirty-seven studies were qualified for both meta-analyses. Results:The pooled 30-day mortality percentages (%) were 4.16% [95% confidence interval (CI): 2.68-5.95](first meta-analysis) and 5.26% (95% CI: 3.47-7.62) (second meta-analysis). Higher percentages of squamous histology and lobectomy, were significantly associated with increased (P=0.001) and decreased (P<0.001) thirty-day postoperative mortality, respectively (first meta-analysis). The pooled percentages for postoperative complications were 34.32% (95% CI: 24.59-44.75) (first meta-analysis) and 45.59% (95% CI: 35.62-55.74) (second metaanalysis). Higher percentages of squamous histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were associated with higher proportions of postoperative complications (second meta-analysis). The pooled threeand five-year survival probabilities were 68.25% (95% CI: 45.93-86.86) and 52.03% (95% CI: 34.71-69.11), respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009) significantly reduced the five-year survival probability.Conclusions: Lobectomy and age were both accompanied by reduced five-year survival rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy for squamous pT1 or pT2 LC displayed a higher risk of postoperative complications. Moreover, medical decision between combined or staged surgery is suggested to be individualized based on adequacy of coronary arterial perfusion, age, patient's preoperative performance status (taking into account possible co-morbidities per patient), tumor's staging and extent of lung resection.

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Section: Discussionmentioning

confidence: 99%

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

Bablekos¹,

Analitis²,

Michaelides³

et al. 2016

Ann. Transl. Med.

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“…These high risk constellations involved both the cardiac status, especially the number of vessels diseased and left ventricular function, and also non-cardiac co-morbidity. Here, severe COPD, disabling cerebrovascular disease, reoperative coronary surgery (15,16,21,22), and calcifying aortic disease were predominant factors (14). For these reasons it soon became obvious that a uniform patient population cannot be generated in this early phase of evaluation of the MIDCAB concept.…”

Section: Discussionmentioning

confidence: 97%

“…This technique has evolved from a number of previous techniques on coronary surgery via sternotomy without the use of extracorporeal circulation (2,4,6,10,12,13,15,17,18,23). In these studies, techniques to slow the heart rate, to stabilize the surface at the site of the anastomosis, and anesthesiological management have been evaluated and defined.…”

Section: Techniques Of Minimally Invasive Coronary Bypassmentioning

confidence: 99%

Perspektiven der operativen Myokardrevaskularisation. Minimal-invasiver Bypass: Eine Alternative?

Haverich

Cremer

1998

Zeitschrift f�r Kardiologie

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Minimally invasive direct coronary artery bypass surgery has evolved as a reliable method to perform left internal mammary artery (LIMA) bypass surgery to the LAD. This novel technique represents a synthesis of known approaches to coronary surgery using sternotomy without extracorporeal circulation and limited access techniques in general thoracic surgery. Applying specially designed tools for both harvesting the internal mammary artery and mechanically stabilizing the anterior surface of the heart during anastomosis, this approach is gaining widespread acceptance. A steadily growing number of patients with proximal LAD lesions are submitted to cardiac surgery and the procedure is performed with increasing success rates, now approaching 98% short term patency. Improved cosmetic results, less surgical trauma, decreased length of stay in the hospital, and comparable longterm results to open LIMA bypass to LAD are the key characteristics of this new approach to single vessel coronary disease.

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“…A colocação de um enxerto em uma artéria nativa com o coração batendo, como já demonstramos, fornece muitas vantagens. Os cuidados intensivos e a permanência hospitalar são diminuí-dos, assim como a morbidade e mortalidade, com maior risco nas urgências e nas reoperações (15,33) .…”

Section: Comentáriosunclassified

Revascularização do miocárdio sem circulação extracorpórea: experiência e resultados iniciais

Brasil¹,

Mariano²,

Santos³

et al. 2000

Rev Bras Cir Cardiovasc

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Calzada A -Revascularização do miocárdio sem circulação extracorpórea: experiência e resultados iniciais.Rev Bras Cir Cardiovasc 2000; 15 (1): 6-15. RESUMO: Fundamentos: A operação de revascularização do miocárdio sem circulação extracorpórea (CEC) vem sendo utilizada como uma alternativa para o tratamento da insuficiência coronariana.Objetivo: Apresentar nossa experiência com este procedimento, descrevendo a técnica empregada e os resultados iniciais.Casuística e Métodos: Foram avaliados 23 pacientes submetidos à revascularização do miocárdio sem CEC. Foram selecionados para este estudo pacientes que apresentavam lesões nas artérias coronárias da região ântero-diafragmática do coração. A principal indicação cirúrgica foi insuficiência coronária crônica (78,3%). O sexo masculino predominou em 65% dos casos. A idade variou de 44 a 80 anos (média: 59,6 anos). A abordagem cirúrgica em todos os pacientes foi através de esternotomia mediana. Os enxertos utilizados foram: as artérias torácicas internas, veia safena e artéria radial.Resultados: O tempo médio de operação foi de 3h15 min. Não houve intercorrências intra-operatórias. O número de enxertos por paciente variou de 1 a 3, num total de 36 enxertos realizados, com média de 1,56 enxerto/paciente. A artéria torácica interna esquerda foi o enxerto mais utilizado (41,7%). As artérias coronárias revascularizadas mais freqüentemente foram o ramo interventricular anterior (52,8%) e a coronária direita (30,5%). A mortalidade hospitalar e a incidência de infarto pós-operatório foram de 4,3%. Não ocorreram complicações neurológicas, pulmonares, renais, hemorrágicas ou infecciosas. O tempo médio de internação hospitalar foi de 7 dias.Conclusão: A revascularização do miocárdio sem CEC é uma técnica eficaz e segura que pode ser realizada em casos selecionados, com baixa morbidade e mortalidade, com redução de custos e do tempo de internação hospitalar. DESCRITORES: Revascularização miocárdica. Circulação extracorpórea. Cardiopatias, cirurgia.Luiz Antônio BRASIL*, João Batista MARIANO*, Fernando Martins dos SANTOS*, André Luiz SILVEIRA*, Nilo de MELO*, Nivaldo Gomes de OLIVEIRA*, Rômulo Sales ANDRADE*, Delzirene Pinheiro BOTELHO*, Antônio CALZADA* INTRODUÇÃO A revascularização cirúrgica do miocárdio se consagrou nestes últimos 30 anos como um procedimento seguro e bem estabelecido para o tratamento da insuficiência coronariana, proporcionando a remissão dos sintomas e contribuindo para o prolongamento e melhora da qualidade de vida de pacientes portadores de doença coronária.

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Reoperative coronary artery bypass grafting without cardiopulmonary bypass

Cited by 98 publications

References 14 publications

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

Perspektiven der operativen Myokardrevaskularisation. Minimal-invasiver Bypass: Eine Alternative?

Revascularização do miocárdio sem circulação extracorpórea: experiência e resultados iniciais

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