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Avoiding sternotomy in repeat coronary artery bypass grafting: Feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery.
J Thorac Cardiovasc Surg. 2012 Jul; 144(1):124-9.JT

Abstract

OBJECTIVES

Repeat sternotomy is associated with a substantial risk of cardiovascular injury. We evaluated the feasibility and clinical outcome of a transabdominal approach without sternotomy and without cardiopulmonary bypass in repeat coronary artery bypass grafting, using the right gastroepiploic artery to graft vessels of the inferior wall of the heart.

METHODS

From July 1999 to October 2010, 22 patients presenting with only right coronary artery disease underwent reoperation using the transabdominal approach and a skeletonized gastroepiploic artery graft. In all patients but 1, a patent graft to the anterior wall was present. The mean EuroSCORE was 6.4 ± 2.5.

RESULTS

All patients had adequate surgical exposure, and no conversion to sternotomy or the use of cardiopulmonary bypass was required. There was no in-hospital mortality. Hospital morbidity included pneumothorax in 1 patient and atrial fibrillation in 2 patients. The median hospital stay was 5 days. Follow-up was complete, and the median follow-up time was 6 years. There were 2 late deaths. Four patients experienced recurrence of angina, of whom three required percutaneous coronary intervention. The estimated freedom from major cardiovascular and cerebrovascular events rate was 70.2% at 6 years. Fourteen patients underwent an exercise stress test at a median interval of 2 years, with all showing no signs of myocardial ischemia.

CONCLUSIONS

Transabdominal off-pump coronary artery bypass grafting using the right gastroepiploic artery is a safe and effective procedure with low in-hospital mortality and morbidity and favorable mid-term outcome. In redo operations, this technique excludes the risk of cardiovascular injury.

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Authors+Show Affiliations

Tavilla G
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. G.Tavilla@ctc.umcn.nl
Bruggemans EF
No affiliation info available

MeSH

AgedCardiopulmonary BypassCoronary Artery Bypass, Off-PumpCoronary DiseaseFeasibility StudiesFemaleFollow-Up StudiesGastroepiploic ArteryHumansLength of StayMaleMiddle AgedPostoperative ComplicationsReoperationSternotomyTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21885067

Citation

Tavilla, Giuseppe, and Eline F. Bruggemans. "Avoiding Sternotomy in Repeat Coronary Artery Bypass Grafting: Feasibility, Safety, and Mid-term Outcome of the Transabdominal Off-pump Technique Using the Right Gastroepiploic Artery." The Journal of Thoracic and Cardiovascular Surgery, vol. 144, no. 1, 2012, pp. 124-9.
Tavilla G, Bruggemans EF. Avoiding sternotomy in repeat coronary artery bypass grafting: Feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery. J Thorac Cardiovasc Surg. 2012;144(1):124-9.
Tavilla, G., & Bruggemans, E. F. (2012). Avoiding sternotomy in repeat coronary artery bypass grafting: Feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery. The Journal of Thoracic and Cardiovascular Surgery, 144(1), 124-9. https://doi.org/10.1016/j.jtcvs.2011.07.060
Tavilla G, Bruggemans EF. Avoiding Sternotomy in Repeat Coronary Artery Bypass Grafting: Feasibility, Safety, and Mid-term Outcome of the Transabdominal Off-pump Technique Using the Right Gastroepiploic Artery. J Thorac Cardiovasc Surg. 2012;144(1):124-9. PubMed PMID: 21885067.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Avoiding sternotomy in repeat coronary artery bypass grafting: Feasibility, safety, and mid-term outcome of the transabdominal off-pump technique using the right gastroepiploic artery. AU - Tavilla,Giuseppe, AU - Bruggemans,Eline F, Y1 - 2011/08/31/ PY - 2011/05/02/received PY - 2011/06/24/revised PY - 2011/07/27/accepted PY - 2011/9/3/entrez PY - 2011/9/3/pubmed PY - 2012/9/29/medline SP - 124 EP - 9 JF - The Journal of thoracic and cardiovascular surgery JO - J Thorac Cardiovasc Surg VL - 144 IS - 1 N2 - OBJECTIVES: Repeat sternotomy is associated with a substantial risk of cardiovascular injury. We evaluated the feasibility and clinical outcome of a transabdominal approach without sternotomy and without cardiopulmonary bypass in repeat coronary artery bypass grafting, using the right gastroepiploic artery to graft vessels of the inferior wall of the heart. METHODS: From July 1999 to October 2010, 22 patients presenting with only right coronary artery disease underwent reoperation using the transabdominal approach and a skeletonized gastroepiploic artery graft. In all patients but 1, a patent graft to the anterior wall was present. The mean EuroSCORE was 6.4 ± 2.5. RESULTS: All patients had adequate surgical exposure, and no conversion to sternotomy or the use of cardiopulmonary bypass was required. There was no in-hospital mortality. Hospital morbidity included pneumothorax in 1 patient and atrial fibrillation in 2 patients. The median hospital stay was 5 days. Follow-up was complete, and the median follow-up time was 6 years. There were 2 late deaths. Four patients experienced recurrence of angina, of whom three required percutaneous coronary intervention. The estimated freedom from major cardiovascular and cerebrovascular events rate was 70.2% at 6 years. Fourteen patients underwent an exercise stress test at a median interval of 2 years, with all showing no signs of myocardial ischemia. CONCLUSIONS: Transabdominal off-pump coronary artery bypass grafting using the right gastroepiploic artery is a safe and effective procedure with low in-hospital mortality and morbidity and favorable mid-term outcome. In redo operations, this technique excludes the risk of cardiovascular injury. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/21885067/Avoiding_sternotomy_in_repeat_coronary_artery_bypass_grafting:_Feasibility_safety_and_mid_term_outcome_of_the_transabdominal_off_pump_technique_using_the_right_gastroepiploic_artery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(11)00836-1 DB - PRIME DP - Unbound Medicine ER -