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Off-Pump Coronary Bypass through Very Limited Sternotomy.
Heart Surg Forum. 2003; 6(4):E63-7.HS

Abstract

OBJECTIVE

This study was designed to evaluate the feasibility of beating heart coronary bypass operations on the anterior vessels of the heart through very limited sternotomy (VLS).

METHODS

Between February 1, 2000, and October 1, 2001, 76 patients with stenosis of the left anterior descending artery (LAD) and right coronary artery (RCA) underwent coronary bypass grafting through 6- to 7-cm T-shaped VLS. Mean age of the patients was 56 +/- 4.7 years. Fourteen patients were women. Nine (12%) of the patients had a left ventricular ejection fraction of less than 35%. Forty-three patients had single-vessel disease, and the others had 2-vessel disease. Patients who needed emergency operations were excluded from the study.

RESULTS

In 7 patients the operation was converted to full sternotomy with or without cardiopulmonary bypass. This outcome accounted for an over all failure rate of 9%. The internal mammary artery/arteries were the inflow vessels in all cases. Various types of composite grafts were created with the saphenous vein and radial artery. Thirty-five (46%) of the patients received a single graft to the LAD, 12 (16%) received 2 grafts to the LAD and RCA, 8 (11%) received 2 grafts to the LAD and a diagonal artery, and 21 (27%) received 3 grafts to the LAD, RCA, and a diagonal artery. Average graft number was 1.8 per patient. Mean operation time was 97 +/- 26 minutes (range, 41-177 minutes). Mean anastomosis time for each graft was 16.0 +/- 2.6 minutes in the first 26 patients and 9.0 +/- 1.7 minutes in the rest. Mean intubation time, intensive care unit, and in-hospital stays were 4.1 +/- 1.6 hours, 17.6 +/- 3.4 hours, and 4.1 +/- 0.8 days, respectively. One (1%) of the patients had perioperative myocardial infarction, and 1 (1%) had right lung laceration and prolonged air leakage. There were no cases of cerebrovascular accident, pulmonary insufficiency, deep wound infection, or renal failure. There was no hospital mortality. The mean followup period was 26. 8 +/- 3.5 months. Thirty-nine (51%) of the patients underwent coronary angiography 1 year after the operation. Fifty-eight grafts were examined. There were 6 occluded grafts, with an overall patency rate of 90%. Three patients died in the follow-up period, 1 (1%) of these patients died of a cardiac cause.

CONCLUSION

Coronary bypass grafting on the LAD, the RCA, and their tributaries can be safely performed through VLS. Early and midterm results are comparable with those of classic methods of myocardial revascularization. Conversion to full sternotomy is quite easy and safe, should the necessity arise.

Authors+Show Affiliations

Department of Cardiac Surgery and Cardiac Anesthesia, Academic Hospital, Istanbul, Turkey. enaseri@turk.netNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12928214

Citation

Naseri, Erdinç, and Meral Sevinç. "Off-Pump Coronary Bypass Through Very Limited Sternotomy." The Heart Surgery Forum, vol. 6, no. 4, 2003, pp. E63-7.
Naseri E, Sevinç M. Off-Pump Coronary Bypass through Very Limited Sternotomy. Heart Surg Forum. 2003;6(4):E63-7.
Naseri, E., & Sevinç, M. (2003). Off-Pump Coronary Bypass through Very Limited Sternotomy. The Heart Surgery Forum, 6(4), E63-7.
Naseri E, Sevinç M. Off-Pump Coronary Bypass Through Very Limited Sternotomy. Heart Surg Forum. 2003;6(4):E63-7. PubMed PMID: 12928214.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-Pump Coronary Bypass through Very Limited Sternotomy. AU - Naseri,Erdinç, AU - Sevinç,Meral, PY - 2003/04/02/received PY - 2003/04/17/accepted PY - 2003/8/21/pubmed PY - 2003/12/4/medline PY - 2003/8/21/entrez SP - E63 EP - 7 JF - The heart surgery forum JO - Heart Surg Forum VL - 6 IS - 4 N2 - OBJECTIVE: This study was designed to evaluate the feasibility of beating heart coronary bypass operations on the anterior vessels of the heart through very limited sternotomy (VLS). METHODS: Between February 1, 2000, and October 1, 2001, 76 patients with stenosis of the left anterior descending artery (LAD) and right coronary artery (RCA) underwent coronary bypass grafting through 6- to 7-cm T-shaped VLS. Mean age of the patients was 56 +/- 4.7 years. Fourteen patients were women. Nine (12%) of the patients had a left ventricular ejection fraction of less than 35%. Forty-three patients had single-vessel disease, and the others had 2-vessel disease. Patients who needed emergency operations were excluded from the study. RESULTS: In 7 patients the operation was converted to full sternotomy with or without cardiopulmonary bypass. This outcome accounted for an over all failure rate of 9%. The internal mammary artery/arteries were the inflow vessels in all cases. Various types of composite grafts were created with the saphenous vein and radial artery. Thirty-five (46%) of the patients received a single graft to the LAD, 12 (16%) received 2 grafts to the LAD and RCA, 8 (11%) received 2 grafts to the LAD and a diagonal artery, and 21 (27%) received 3 grafts to the LAD, RCA, and a diagonal artery. Average graft number was 1.8 per patient. Mean operation time was 97 +/- 26 minutes (range, 41-177 minutes). Mean anastomosis time for each graft was 16.0 +/- 2.6 minutes in the first 26 patients and 9.0 +/- 1.7 minutes in the rest. Mean intubation time, intensive care unit, and in-hospital stays were 4.1 +/- 1.6 hours, 17.6 +/- 3.4 hours, and 4.1 +/- 0.8 days, respectively. One (1%) of the patients had perioperative myocardial infarction, and 1 (1%) had right lung laceration and prolonged air leakage. There were no cases of cerebrovascular accident, pulmonary insufficiency, deep wound infection, or renal failure. There was no hospital mortality. The mean followup period was 26. 8 +/- 3.5 months. Thirty-nine (51%) of the patients underwent coronary angiography 1 year after the operation. Fifty-eight grafts were examined. There were 6 occluded grafts, with an overall patency rate of 90%. Three patients died in the follow-up period, 1 (1%) of these patients died of a cardiac cause. CONCLUSION: Coronary bypass grafting on the LAD, the RCA, and their tributaries can be safely performed through VLS. Early and midterm results are comparable with those of classic methods of myocardial revascularization. Conversion to full sternotomy is quite easy and safe, should the necessity arise. SN - 1522-6662 UR - https://www.unboundmedicine.com/medline/citation/12928214/Off_Pump_Coronary_Bypass_through_Very_Limited_Sternotomy_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -