Search Results (6)

Background: Minimally invasive multi-vessel off-pump coronary artery bypass grafting (MICS CABG) through left anterior mini-thoracotomy avoids both extracorporeal circulation and sternotomy and is a very elegant, safe, and effective surgical technique, despite its still-limited adoption in the daily toolkit of cardiac surgeons. The goal of this retrospective, single-centre analysis was to evaluate the long-term outcomes of a large patient cohort undergoing MICS CABG. Methods: This study identified 597 consecutive MICS CABG patients from August 2008 to November 2020. We obtained follow-up data by phone or mail. Every patient had a left internal thoracic artery bypass graft. The second and possibly third grafts were radial arteries, great saphenous vein segments, or right internal thoracic arteries. Results: The median age was 69 years, and 92.1% were male. The median EuroSCORE II was 1.5. There were eight conversions to sternotomy and none to cardiopulmonary bypass. The total arterial revascularisation was 92.5%, with 90.3% complete. The 30-day mortality was 0.5%. A total of 575 patients (95.8%) were tracked for 8 years on average. A Cox regression analysis found that a left ventricular ejection fraction < 50%, peripheral vascular disease, chronic kidney disease, and a history of cerebrovascular accident independently predicted severe adverse cardiac and cerebrovascular events and late death. The actuarial survival rates for one, three, five, eight, and ten years were 99%, 95%, 91%, 85%, and 80%, respectively. Conclusions: In our study group, the technique of MICS CABG has been proven to be a safe and effective surgical revascularisation method, with a low rate of early complications and favourable long-term outcomes in eligible patients. Full article

Hybrid coronary revascularisation (HCR) integrates coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to combine the benefits of minimally invasive surgery and advanced stent technology. Typically, HCR involves off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) bypass via minimally invasive direct coronary artery bypass (MIDCAB), complemented by PCI to non-LAD vessels. This approach avoids a full sternotomy and cardiopulmonary bypass while preserving the advantages of surgical revascularisation. Patient selection for HCR should be guided by a multidisciplinary heart team, targeting those with severe LAD disease and suitable non-LAD lesions for PCI. This review outlines the surgical techniques, anticoagulation strategies, and procedural sequencing employed in HCR, along with real-world outcomes from observational studies and randomised trials. While current evidence supports the safety and feasibility of HCR in appropriately selected patients, further large-scale randomised trials are needed to clarify its role in comparison to standalone CABG or PCI. Full article

Background and Objectives: Surgical revascularisation of patients with atherosclerosis of the ascending aorta remains a challenge. Different surgical strategies have been described in coronary surgical patients to offer alternative revascularisation strategies other than the conventional surgical revascularisation in patients unsuitable for it. The aim of this study is to compare the real-world outcomes between two groups of patients who underwent off-pump surgery (left internal mammary artery graft to the left anterior descending artery) or a hybrid with a percutaneous revascularisation procedure at a later stage. Materials and Methods: This is a single-centre retrospective observational study. Between the years 2010 and 2021, 91/6863 patients (1.33%) were diagnosed with severe atherosclerosis of the ascending aorta. All the patients were treated with off-pump revascularisation (91 patients), and the cardiologist would decide at a later stage whether the rest of the vessels would be treated with percutaneous revascularisation (25 patients). Results: There was no statistical difference in the various preoperative characteristics, except for coronary artery left main disease (30.30% vs. 64%; p = 0.0043). The two groups had no statistical differences in the perioperative characteristics and postoperative complications. The 1-, 5-, and 10-year mortality rates in the two groups were 6.1% vs. 0%, 59% vs. 80%, and 93.9% vs. 100%, respectively (off-pump vs. hybrid with percutaneous revascularisation procedure, p = 0.1958). Conclusions: Both strategies have high long-term comparable mortality. The off-pump surgery and the HCR procedure at a later stage may be solutions for these high-risk patients, but the target treatment should be complete HCR revascularisation during the index hospitalization. Full article

Objectives: Robot-assisted coronary revascularisation is a relatively new strategy. By performing a minimally invasive left internal thoracic artery (LITA) to left anterior descending (LAD) artery bypass, we are taking advantage of the survival benefit of the LITA-to-LAD bypass while decreasing the morbidity of the procedure associated with sternal spreading. The objective was to assess clinical outcomes and graft patency at 3 years.
Methods: From March 2011 to July 2014, 17 consecutive patients were operated on, with robotic LITA harvesting and manual anastomosis to the LAD on the beating heart through a small anterior thoracotomy. Patients underwent coronary (n = 6) or computed tomographic angiography (n = 11) 1 year after the operation.
Results: All patients were successfully revascularised as planned. There were no early or late deaths. All patients were fast tracked, with extubation during the first 2 hours in the intensive care unit, or (for six of them) in the operating theatre. The mean hospital stay was 4 ± 1.1 days. No patient required reoperation or re-exploration for bleeding. Follow-up ranged from 18 to 48 months. At 1 year, all patients had a patent LITA-LAD anastomosis. All patients remain symptom-free with a negative stress test at latest follow-up.
Conclusions: Robotic LITA takedown and minimally invasive off-pump LAD revascularisation results in excellent perioperative outcomes, high graft patency and freedom from angina during follow-up. Full article

We report a case of a 75-year-old male suffering from Werlhof ’s disease and coronary artery disease undergoing off-pump coronary artery bypass grafting (OPCAB). At the time of admission, platelet count was 24
× 10³/μl. After four days of treatment with Octagam^® (Octapharma, Switzerland), an intravenous immune globulin, preoperative platelet count increasd to 80
× 10³/μl. To prevent potential bleeding complications two units of thrombocytes were administered intraoperatively. Revascularisation was uneventful. The patient was discharged from ICU on post-operative day (POD) 1. Total chest drainage was 920 ml, requiring the transfusion of one red blood cell concentrate only. Further postoperative course was uneventful and the patient was discharged from hospital on POD 9. We conclude that in patients with Werlhof ’s disease OPCAB surgery can be safely performed. Full article

Recent advances in percutaneous coronary intervention (PCI) techniques and progress made with drug-eluted stents as well as with post-interventional anti-thrombotic management have increased the number of patients with three vessel coronary artery disease who are nowadays initially treated interventionally. However, coronary artery bypass grafting (CABG) has proven to be as effective as percutaneous methods, although these approaches are selected for different states of the disease. This is especially true for diabetic patients who generally demonstrate a greater mid- to long-term benefit following CABG than PCI. Nevertheless, surgery should also integrate the most recent advances like total arterial revascularisation and off-pump techniques in selected cases. Full article