| Ministernotomy in myocardial revascularization without cardiopulmonary bypass: technical aspects and early results. | |
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MedLine Citation:
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PMID: 12114132 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: This study attempts to evaluate the feasibility of ministernotomy in beating heart coronary surgery, with special emphasis on technical aspects. METHODS: From September 1997 to September 1999, 137 patients were scheduled for off-pump coronary surgery in our institution. In 61 cases requiring revascularization of the left anterior descending artery (LAD) and right coronary artery (RCA) systems, the approach was either a reversed "L-shaped " ministernotomy (56 patients) or a "T-shaped " ministernotomy (five patients). Mean age of the ministernotomy patients was 64 +/- 10 years, and 17 of the patients were female. The mean left ventricular ejection fraction (LVEF) was 60 +/- 11% (<35% in four patients), and 32 patients (52.5%) had one-vessel disease while 29 (47.5%) had 2-vessel or 3-vessel diseases. There were seven (11.4%) urgent procedures. For these procedures, we used devices that we designed ourselves for sternal retraction and coronary stabilization. RESULTS: Five patients (8.2%) needed conversion to another method due to hemodynamic instability or ischemia, while 56 of the patients completed the procedure. Fifty-one patients (91.1%) had a single graft on the LAD, four (7.1%) had a double graft on the LAD and the right or diagonal coronary artery, and one (1.8%) had a triple graft on the LAD and two diagonal branches. Mean coronary occlusion times and operative times were 12.1 +/- 2.7 and 152 +/- 33 minutes, respectively. Mean creatine kinase value was 29.8 +/- 24.6. One patient died of acute myocardial infarction, and one patient had temporary acute renal failure. Mean in-hospital stay was 5.2 +/- 1.9 days. Of the 18 patients (32.1%) who had postoperative angiographic control (range of 1 to 13 months), 17 showed patent anastomoses, and one required percutaneous transluminal coronary angioplasty (PTCA) of the anastomosis on the LAD. Mean follow-up time for all patients was 10.8 +/- 6.4 months. Freedom from any kind of repeat procedure was 98.2%. CONCLUSION: Ministernotomy is a safe approach for patients not requiring grafts on the circumflex system. The possibility of multiple grafting and the easy conversion to a conventional surgical method make ministernotomy a preferable approach for minimally invasive coronary surgery. |
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Authors:
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Giovanni Troise; Federico Brunelli; Marco Cirillo; Zen Mhagna; Giordano Tasca; Bruno Amari; Gian Battista Danzi; Eugenio Quaini |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The heart surgery forum Volume: 5 ISSN: 1098-3511 ISO Abbreviation: Heart Surg Forum Publication Date: 2002 |
Date Detail:
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Created Date: 2002-07-12 Completed Date: 2002-09-12 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 100891112 Medline TA: Heart Surg Forum Country: United States |
Other Details:
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Languages: eng Pagination: 168-72 Citation Subset: IM |
Affiliation:
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Department of Cardiac Surgery, Poliambulanza Hospital, Brescia, Italy. quaini@gsnet.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Cardiopulmonary Bypass Feasibility Studies Female Follow-Up Studies Humans Male Middle Aged Myocardial Revascularization / methods* Postoperative Complications / epidemiology Sternum / surgery* Surgical Procedures, Minimally Invasive Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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