Routine minimally invasive approach via left anterior mini-thoracotomy in multivessel coronary revascularization

Barış Çaynak, Hüseyin Sicim
Journal of Cardiac Surgery 2022, 37 (4): 769-776

BACKGROUND: Minimally invasive heart surgery continues to spread rapidly around the world. Although coronary artery bypass surgery with median sternotomy continues to be performed intensively in many centers, the results of the new literature continue to contribute to proving the reliability of minimally invasive coronary surgery. In this study, we aimed to contribute to the routine feasibility of minimally invasive coronary bypass with left anterior mini-thoracotomy with our own case series.

METHODS: From July 2019 to August 2021 a total of 184 nonselected consecutive patients underwent minimally invasive on-pump multivessel coronary artery bypass grafting through the left anterior minithoracotomy in the fourth intercostal space. In the operation decision; regardless of low ejection fraction, morbid obesity, number of diseased vessels, or other comorbid factors, bypass operation was performed routinely via thoracotomy without selecting patients, except redo patients or porcelain aorta. The mean number of grafts was 3.3 ± 0.5. Left internal mammary artery was used in all patients. For other anastomoses; saphenous vein graft was used. Cardiopulmonary bypass (CPB), aortic cross-clamping, and blood cardioplegia were used in all patients. Postoperative results of all patients were analyzed retrospectively.

RESULTS: The total CPB time was 144.5 ± 27.3 min, and aortic cross-clamp time 82.1 ± 16.2 min. The mean intensive care stay was 1.2 ± 0.7 days and mean total hospital stay 5.1 ± 1.2 days. Total perioperative mortality was 0.54% (one patient). Myocardial infarction was not observed in any case in the postoperative period. The cause of mortality was delayed tamponade occurring on the fifth postoperative day. Nine patients underwent revision due to bleeding in the early postoperative period. There was no patient who underwent stroke or developed renal failure requiring hemodialysis in the postoperative period. One hundred and eighty-three patients (99.4%) were discharged with good recovery.

CONCLUSION: Minimally invasive multivessel bypass surgery is a surgical method that has just started to become widespread. The fact that the technique is new and more challenging than conventional methods makes it difficult for surgeons to adopt it. In addition, one of the most important issues is that the surgical results should be satisfactory. Our study shows that safe, successful, and satisfactory results can be obtained by using this method, as in our case series. In addition, we think that it can be successfully applied routinely to all patients without distinction.

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