Xiphoid Lower-Sternotomy Approach for Multivessel Revascularization of the Left Internal Mammary Artery to the Left Anterior Descending Artery and Right Internal Mammary Artery Inflow to the Other Vessels

Benetti, Federico; Prapas, Sotirios; Angeletti, Ernesto; Ameriso, José Luis; Cicalle, Eduardo; Klokočovnik, Tomislav; Kneževič, Ivan; Geršak, Borut

doi:10.1532/hsf98.20091131

Cited by 3 publications

(5 citation statements)

References 13 publications

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“…We have done the MINI-OPCAB operation for single and multiple diseased vessels in more than 150 patients in different centers around the World; [5] of these cases, 70 patients underwent MINI-OPCAB operation with LIMA-LAD bypass from 1997 to 2021 in our Foundation, and 10 of them received concomitant hybrid revascularization. The mean age of the patients was 67 years, 23 (33%) had triple vessels disease, 18 (26%) had double vessels disease, 26 (37%) had single-vessel disease, and 3 (4%) had severe left main disease.…”

Section: Methodsmentioning

confidence: 99%

Left Internal Mammary Artery to Left Anterior Descending Artery. An Alternative for old, High-Risk, Multivessel, Coronary Artery Disease Patients and an Approach for Hybrid Revascularization

Benetti¹,

Gonzalez²,

Scialacomo³

2022

JCCI

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In 1997, the first ambulatory off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) anastomosis was performed via xiphoid approach, an intervention known today as the MINI-OPCAB operation. This operation has been performed in more than 150 patients around the world for the management of single and multiple vessel coronary artery disease, and 70 of those cases underwent the procedure in our Foundation from 1997 to 2021, showing no operative mortality or reintervention rates, low conversion rates, early hospital discharge, and 100% graft patency at the follow-ups. The minimally invasive direct coronary artery bypass (MIDCAB) procedure was introduced in 1994 by Benetti from Argentina, and was developed based on our previous experience performing off-pump coronary surgery by manipulating the ascending aorta through a left-sided small thoracotomy. Although it represents one of the most common minimally invasive procedures done worldwide, the original technique is not easy to reproduce, and in most cases the pleura is opened, which increases patients pain, morbidity, hospital length of stay, and hinders the realization of immediate hybrid revascularization after the procedure. The latest minimally invasive approaches for CABG include robotic-assisted procedures, in which the IMAs are harvested using robotic technology or the whole procedure is done using robotic technology. This approach has shown adequate short-term clinical results, however, there are no studies available reporting the procedure’s long-term results. Conclusion: The MINI-OPCAB operation is a friendly approach to perform Minimally Invasive Coronary Bypass Surgery in old, high-risk, multivessel coronary artery disease patients, and it represents a good intervention alternative for the majority of cardiac surgeons and cardiac specialized centers. We also consider this approach as ideal for patients who further require Hybrid Revascularization; however, more experience is needed to validate this initials results.

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Section: Methodsmentioning

confidence: 99%

Left Internal Mammary Artery to Left Anterior Descending Artery. An Alternative for old, High-Risk, Multivessel, Coronary Artery Disease Patients and an Approach for Hybrid Revascularization

Benetti¹,

Gonzalez²,

Scialacomo³

2022

JCCI

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“…In conclusion, the work of Quan et al 1 remarks on the importance of the use of TTFM to reduce the incidence of preoperative myocardial injury during off‐pump coronary bypass surgery. Support of, in some ways, the recent expert opinion to promote the use of TTFM 10 …”

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“…3,4 Using TTFM, we can reconsider the most common use of OPCAB in situations of acute AMI where we can give the patient a better longterm survival, such as a Lima to Lad or arterial conduits in a young patient, or situations where we can do a MIDCAB and the variables, MINI OPCAB (lower middle incisions), or ROBOTIC operations. [5][6][7][8][9][10] A systematic review of the evidence and expert opinion statements, 11 concluded that although TTFM use may increase the cost and duration of the procedure and requires a learning curve, its cost/benefit ratio seems largely favorable, in view of the potential clinical consequences of graft dysfunction. These consensus statements will help to standardize the use of TTFM in clinical practice and provide guidance in clinical decision-making.…”

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confidence: 99%

“…Technology, such as flowmetry, was not available to quantify flow measurements in coronary grafts, and the degree of myocardial damage immediately after surgery 3,4 . Using TTFM, we can reconsider the most common use of OPCAB in situations of acute AMI where we can give the patient a better long‐term survival, such as a Lima to Lad or arterial conduits in a young patient, or situations where we can do a MIDCAB and the variables, MINI OPCAB (lower middle incisions), or ROBOTIC operations 5–10 . A systematic review of the evidence and expert opinion statements, 11 concluded that although TTFM use may increase the cost and duration of the procedure and requires a learning curve, its cost/benefit ratio seems largely favorable, in view of the potential clinical consequences of graft dysfunction.…”

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confidence: 99%

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The use of intraoperative transit time flow measurement can reduce preoperative myocardial injury

Benetti

2022

Journal of Cardiac Surgery

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patients undergoing off-pump coronary artery bypass grafting surgical procedures with general anesthesia were eligible. If they met one of the following criteria, patients were excluded: postoperative troponin did not reach normal value; combined with other valve surgery and significant liver dysfunction; died within 1 week after surgery. And after excluding 30 patients who did not meet the criteria, 146 patients were eventually included in the trial. In these studies, the postoperative myocardial injury was defined as an independent rise in cardiac troponin (from baseline) 70 times the upper reference limit (URL) according to ARC-2 criteria 10, regardless of the symptoms of ischemia and electrocardiogram changes, within this study, specifically 2380 ng/L.

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“…24 We used the right mammary as inflow from many years in sternotomy off pump when the patient had a porcelain aorta, and we expanded this technique for the MINI OPCAB operation in multiple vessels. 25 With these and other, contributions regarding to different conduits adapted to the OPCAB, this surgery is today established worldwide. The future requires a bypass operation more minimally invasive, easy to reproduce and with possibilities to be done in the entire world.…”

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The History of Off-Pump Coronary Bypass (OPCAB)

Benetti¹,

Scialacomo²

2017

OAJTMR

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Despite Alexis Carrel early description of experimental coronary artery bypass graft, 1 surgeons were unable to translate these techniques successfully to humans due to a lack of technology and tools to operate on the unsupported beating heart. In 1952, Demikhov described the use of the LITA to directly graft the left anterior descending in dogs, with graft patency confirmed for up to 2-years. 2 Similar early success with the use of the ITA was reported by Canadian surgeon Gordon Murray. 3 Willian Longmire was apparently the first surgeon in performing an Off-pump coronary artery bypass operation. He said they performed a couple of the earliest internal mammary coronary anastomosis when they were forced into it when the coronary artery they were endarterectomizing disintegrated and in the desperation they anastomoses the left internal mammary artery to the distal end of the right coronary artery. 4

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Xiphoid Lower-Sternotomy Approach for Multivessel Revascularization of the Left Internal Mammary Artery to the Left Anterior Descending Artery and Right Internal Mammary Artery Inflow to the Other Vessels

Abstract: This minimally invasive technique is a useful alternative for complete revascularization. The sternal mammary supply and the upper part of the sternum are preserved.

Cited by 3 publications

References 13 publications

Left Internal Mammary Artery to Left Anterior Descending Artery. An Alternative for old, High-Risk, Multivessel, Coronary Artery Disease Patients and an Approach for Hybrid Revascularization

Left Internal Mammary Artery to Left Anterior Descending Artery. An Alternative for old, High-Risk, Multivessel, Coronary Artery Disease Patients and an Approach for Hybrid Revascularization

The use of intraoperative transit time flow measurement can reduce preoperative myocardial injury

The History of Off-Pump Coronary Bypass (OPCAB)

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