Minimally Invasive Coronary Artery Bypass Grafting via a Left Minithoracotomy for Multivessel Coronary Artery Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P. R. China;

Corresponding?author：

Keywords：

Minimally invasive direct coronary artery bypass grafting; Left internal mammary artery; Saphenous vein; Radial artery

DOI：

10.7507/1007-4848.20160182

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Objective To explore the outcomes achieved by using left internal mammary artery (LIMA) to radial artery (RA) or saphenous vein (SV) Y-composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease. Methods From January 2009 through May 2015, 56 patients (36 males and 20 females) with multiple vessel disease underwent MIDCAB with LIMA-RA or LIMA-SV Y-composite grafts without cardiopulmonary bypass in our hospital. MIDCAB was performed through a left anterior minithoracotomy. Thirty four patients used LIMA-RA grafts, and twenty two patients used LIMA-SV grafts. Results All patients success-fully underwent MIDCAB with LIMA-SV or LIMA-RA Y-composite grafts. No patient required to convert to sternotomy during the surgery. Revascularization was performed for 2 target vessels in 12 patients, 3 target vessels in 41 patients and 4 target vessels in 3 patients. Mean postoperative ventilation time was 27.14±31.35 h. Mean ICU time was 3.16±2.53 d, and mean postoperative inhosptial time was 11.89±3.91 d. Thirty-day mortality was 1.79% (1/56). At a follow-up of 1 to 77 months, no patients received revascularization. The overall survival at 2 years postoperatively was 94.4%±5.4% in the LIMA-RA group and 86.8%±9.2% in the LIMA-SV group (P=0.299). The patency rate of LIMA was 100.0%. The overall patency rate of RA or SV grafts at 2 years postoperatively was 90.3%±5.3% or 86.7%±6.3% with no statistical difference (P=0.265). Conclusion MIDCAB with LIMA-RA or LIMA-SV Y-composite grafts is a safe and an effective procedure with favorable early and mid-term outcomes for patients with multiple vessel disease. LIMA-SV composite graft can be used as an alternative graft for patient whose RA is not possible or advisable.

Citation： JIANGZhao-lei, TANGMin, LIUHao, DINGFang-bao, BAOChun-rong, MANan, ZHANGJun-wen, MEIJu. Minimally Invasive Coronary Artery Bypass Grafting via a Left Minithoracotomy for Multivessel Coronary Artery Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(8): 755-759. doi: 10.7507/1007-4848.20160182 Copy

1.	?Mack MJ, Pfister A, Bachand D, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg, 2004, 127(1):167-173.
2.	Vallely MP, Potger K, McMillan D, et al. Anaortic techniques reduce neurological morbidity after off-pump coronary artery bypass surgery. Heart Lung Circ, 2008, 17(4):299-304.
3.	Likosky DS, Marrin CA, Caplan LR, et al. Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke, 2003, 34(12):2830-2834.
4.	Misfeld M, Brereton RJL, Sweetman EA, et al. Neurologic complica-tions after off-pump coronary artery bypass grafting with and without aortic manipulation:meta-analysis of 11, 398 cases from 8 studies. J Thorac Cardiovasc Surg, 2011, 142(2):e11-e17.
5.	Lev-Ran O, Braunstein R, Sharony R, et al. No-touch aorta off-pump coronary surgery:the effect on stroke. J Thorac Cardiovasc Surg, 2005, 129(2):307-313.
6.	Misfeld M, Potger K, Ross DE, et al. "Anaortic" off-pump coronary artery bypass grafting significantly reduces neurological complica-tions compared to off-pump and conventional on-pump surgery with aortic manipulation. Thorac Cardiovasc Surg, 2010, 58(7):408-414.
7.	Achouh P, Boutekadjirt R, Toledano D, et al. Long-term(5-to 20-year) patency of the radial artery for coronary bypass grafting. J Thorac Cardiovasc Surg, 2010, 140(1):73-79.
8.	Schwann TA, Zacharias A, Riordan CJ, et al. Sequential radial artery grafts for multivessel artery bypass graft surgery:10-year survival andn angiography results. Ann Thorac Surg, 2009, 88(1):31-39.
9.	Hayward PAR, Gordon IR, Hare DL, et al. Comparable patencies of the radial artery and right internal thoracic artery or saphenous vein beyond 5 years:results from the radial artery patency and clinical outcomes trial. J Thorac Cardiovasc Surg, 2010, 139(1):60-67.
10.	Goldman S, Sethi GK, Holman W, et al. Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery. JAMA, 2011, 305(2):167-74.
11.	Kotoh K, Fukahara K, DoiT, et al. Predictors of early postoperative cerebral infarction after isolated off-pump coronary artery bypass grafting. Ann Thorac Surg, 2007, 83(5):1679-1683.
12.	Kim KB, Kang CH, Chang WI, et al. Off-pump coronary artery bypass with complete avoidance of aortic manipulation. Ann Thorac Surg, 2002, 74(4):S1377-S382.
13.	Elmistekawy EM, Gawad N, Bourke M, et al. Is bilateral internal thoracic artery use safe in the elderly? J Card Surg, 2012, 27(1):1-5.
14.	Davierwala PM, Leontyev S, Misfeld M, et al. No-touch aorta off-pump coronary bypass operation:arteriovenous composite grafts may be used as a last resort. Ann Thorac Surg, 2013, 95(3):846-852.
15.	姜兆磊, 梅舉, 湯敏, 等.乳內動脈-大隱靜脈復合橋血管在老年人非體外循環冠狀動脈旁路移植術的應用及中期隨訪結果.中國胸心血管外科臨床雜志, 2015, 22(4):284-287.
16.	姜兆磊, 梅舉, 湯敏, 等. MIDCAB術治療心肌橋與非心肌橋性左前降支病變的臨床效果分析.中國心血管病研究, 2014, 12(3):193-196.
17.	Glineur D, Boodhwani M, Poncelet A, et al. Comparison of fractional flow reserve of composite Y-grafts with saphenous vein or right internal thoracic arteries. J Thorac Cardiovasc Surg, 2010, 140(3):639-645.
18.	Li J, Liu Y, Zheng J, et al. The patency of sequential and individual vein coronary bypass grafts:a systematic review. Ann Thorac Surg, 2011, 92(4):1292-1298.
19.	Nambiar P, Mittal C. Minimally invasive coronary bypass using internal thoracic arteries via a left minithoracotomy:"the Nambiar Technique". Innovations (Phila), 2013, 8(6):420-426.
20.	Pande S, Agarwal SK, Gupta D, et al. Early and mid-term results of minimally invasive coronary artery bypass grafting. Indian Heart J, 2014, 66(2):193-196.
21.	McGinn JT Jr, Usman S, Lapierre H, et al. Minimally invasive coronary artery bypass grafting:dual-center experience in 450 conse-cutive patients. Circulation, 2009, 120(11 Suppl):S78-S84.

1. ?Mack MJ, Pfister A, Bachand D, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg, 2004, 127(1):167-173.
2. Vallely MP, Potger K, McMillan D, et al. Anaortic techniques reduce neurological morbidity after off-pump coronary artery bypass surgery. Heart Lung Circ, 2008, 17(4):299-304.
3. Likosky DS, Marrin CA, Caplan LR, et al. Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke, 2003, 34(12):2830-2834.
4. Misfeld M, Brereton RJL, Sweetman EA, et al. Neurologic complica-tions after off-pump coronary artery bypass grafting with and without aortic manipulation:meta-analysis of 11, 398 cases from 8 studies. J Thorac Cardiovasc Surg, 2011, 142(2):e11-e17.
5. Lev-Ran O, Braunstein R, Sharony R, et al. No-touch aorta off-pump coronary surgery:the effect on stroke. J Thorac Cardiovasc Surg, 2005, 129(2):307-313.
6. Misfeld M, Potger K, Ross DE, et al. "Anaortic" off-pump coronary artery bypass grafting significantly reduces neurological complica-tions compared to off-pump and conventional on-pump surgery with aortic manipulation. Thorac Cardiovasc Surg, 2010, 58(7):408-414.
7. Achouh P, Boutekadjirt R, Toledano D, et al. Long-term(5-to 20-year) patency of the radial artery for coronary bypass grafting. J Thorac Cardiovasc Surg, 2010, 140(1):73-79.
8. Schwann TA, Zacharias A, Riordan CJ, et al. Sequential radial artery grafts for multivessel artery bypass graft surgery:10-year survival andn angiography results. Ann Thorac Surg, 2009, 88(1):31-39.
9. Hayward PAR, Gordon IR, Hare DL, et al. Comparable patencies of the radial artery and right internal thoracic artery or saphenous vein beyond 5 years:results from the radial artery patency and clinical outcomes trial. J Thorac Cardiovasc Surg, 2010, 139(1):60-67.
10. Goldman S, Sethi GK, Holman W, et al. Radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery. JAMA, 2011, 305(2):167-74.
11. Kotoh K, Fukahara K, DoiT, et al. Predictors of early postoperative cerebral infarction after isolated off-pump coronary artery bypass grafting. Ann Thorac Surg, 2007, 83(5):1679-1683.
12. Kim KB, Kang CH, Chang WI, et al. Off-pump coronary artery bypass with complete avoidance of aortic manipulation. Ann Thorac Surg, 2002, 74(4):S1377-S382.
13. Elmistekawy EM, Gawad N, Bourke M, et al. Is bilateral internal thoracic artery use safe in the elderly? J Card Surg, 2012, 27(1):1-5.
14. Davierwala PM, Leontyev S, Misfeld M, et al. No-touch aorta off-pump coronary bypass operation:arteriovenous composite grafts may be used as a last resort. Ann Thorac Surg, 2013, 95(3):846-852.
15. 姜兆磊, 梅舉, 湯敏, 等.乳內動脈-大隱靜脈復合橋血管在老年人非體外循環冠狀動脈旁路移植術的應用及中期隨訪結果.中國胸心血管外科臨床雜志, 2015, 22(4):284-287.
16. 姜兆磊, 梅舉, 湯敏, 等. MIDCAB術治療心肌橋與非心肌橋性左前降支病變的臨床效果分析.中國心血管病研究, 2014, 12(3):193-196.
17. Glineur D, Boodhwani M, Poncelet A, et al. Comparison of fractional flow reserve of composite Y-grafts with saphenous vein or right internal thoracic arteries. J Thorac Cardiovasc Surg, 2010, 140(3):639-645.
18. Li J, Liu Y, Zheng J, et al. The patency of sequential and individual vein coronary bypass grafts:a systematic review. Ann Thorac Surg, 2011, 92(4):1292-1298.
19. Nambiar P, Mittal C. Minimally invasive coronary bypass using internal thoracic arteries via a left minithoracotomy:"the Nambiar Technique". Innovations (Phila), 2013, 8(6):420-426.
20. Pande S, Agarwal SK, Gupta D, et al. Early and mid-term results of minimally invasive coronary artery bypass grafting. Indian Heart J, 2014, 66(2):193-196.
21. McGinn JT Jr, Usman S, Lapierre H, et al. Minimally invasive coronary artery bypass grafting:dual-center experience in 450 conse-cutive patients. Circulation, 2009, 120(11 Suppl):S78-S84.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Minimally Invasive Coronary Artery Bypass Grafting via a Left Minithoracotomy for Multivessel Coronary Artery Disease

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