| Mammary coronary artery anastomosis without cardiopulmonary bypass through minithoracotomy: one year clinical experience. | |
| | |
MedLine Citation:
|
PMID: 9814789 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: The recent concept of minimally invasive coronary artery surgery in selected patients has dramatically affected surgical management of coronary artery disease. We explored the possibility of coronary artery bypass grafting of anterior coronary arteries with in situ internal mammary artery through a limited anterior thoracotomy on beating heart. METHOD: Minithoracotomy and direct coronary artery surgery without cardiopulmonary bypass (CPB) was attempted in 116 patients. The procedure was completed in 108 cases while in eight cases minithoracotomy was converted to mid sternotomy. In 107 cases, left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery anastomosis was done through left anterior minithoracotomy and in one case LIMA to LAD and right internal mammary artery (RIMA) to right coronary artery (RCA) anastomosis was done through bilateral minithoracotomy. Left anterior minithoracotomy through 4th intercostal space and right anterior minithoracotomy through 5th intercostal space was used for left and right internal mammary artery dissection respectively. With this approach 4-8 cm length of mammary artery was easily dissected. Mammary coronary artery anastomosis were performed on a beating heart without CPB through window pericardiotomy. Two patients also underwent left carotid endarterectomy along with LIMA to LAD anastomosis. In two patients complementary percutaneous transluminal coronary angioplasty (PTCA) to circumflex artery was done 5 days after minithoracotomy and LIMA to LAD anastomosis. RESULTS: Forty-two patients were extubated in the operating room and 66 in the intensive care unit 2-10 h after surgery. Blood transfusion was used in one case who was reexplored for postoperative bleeding due to a displaced hemoclip from the internal mammary artery branch. None of these patients required inotropic support. Postoperative predischarge check angiogram in 53 cases revealed adequate mammary coronary flow in 51 cases, the remaining two had anastomotic problems, one was subjected to PTCA and the other for redo coronary bypass grafting through mid sternotomy. Doppler flow assessment of anastomosis was done in 102 cases, of which two showed problems which was confirmed on check angiography. One-hundred and six patients are in our regular follow-up (mean follow-up 10+/-1.5 months), 98 of them are in functional class I. CONCLUSION: In our experience mammary coronary artery anastomosis without CPB through minithoracotomy is a safe, simple and minimally invasive procedure. Favorable cost/benefit ratio, has been achieved due to no early/late mortality and minimal early morbidity. Postoperative check angiogram and Doppler flow study revealed excellent mid term results. |
| | |
Authors:
|
Y Mishra; Y Mehta; S Mittal; M Mairal; A Karlekar; A Seth; T S Kler; N Trehan |
Related Documents
:
|
20944199 - Late-presenting left internal mammary to great cardiac vein fistula treated with a vasc... 9930429 - Evaluation of a porcine internal mammary artery (no-react ii) as a small-diameter conduit. 20731269 - Endovascular coiling of an internal mammary artery pseudoaneurysm following placement o... 10952349 - Left internal thoracic artery harvesting in pleural symphyses under minimally invasive ... 11758059 - A xiphoid approach for minimally invasive coronary artery bypass surgery. 22293199 - Cgmp-dependent protein kinase iα transfection inhibits hypoxia-induced migration, phen... 17171169 - The extreme lateral transcondylar approach to aneurysms of the vertebrobasilar junction... 23181279 - Differences between femoral artery and vein smooth muscle cells in volume-regulated chl... 16439729 - Painless aortic dissection with bilateral carotid involvement presenting with vertigo a... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Volume: 14 Suppl 1 ISSN: 1010-7940 ISO Abbreviation: Eur J Cardiothorac Surg Publication Date: 1998 Oct |
Date Detail:
|
Created Date: 1999-01-19 Completed Date: 1999-01-19 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: NETHERLANDS |
Other Details:
|
Languages: eng Pagination: S31-7 Citation Subset: IM |
Affiliation:
|
Escorts Heart Institute and Research Centre, New Delhi, India. ehirc@giasd1.01.vsnl.net.in |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Cardiopulmonary Bypass* Endarterectomy, Carotid / methods Female Follow-Up Studies Humans Internal Mammary-Coronary Artery Anastomosis / methods*, statistics & numerical data Male Middle Aged Postoperative Complications / epidemiology Sternum / surgery Surgical Procedures, Minimally Invasive / methods, statistics & numerical data Thoracotomy / methods Time Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: MIDCAB characteristics and results: the CardioThoracic Systems (CTS) registry.
Next Document: Coronary artery bypass grafting without cardiopulmonary bypass--initial experience of 50 cases.