37. Total Coronary Revascularization via Left Anterior Thoracotomy Using Arterial Conduits
Volodymyr Demianenko, Oleksandr Babliak
Diagnostic and Treatment Center for Children and Adults of the Dobrobut Medical Network, Kyiv, Ukraine
Invited Discussant: Hirokuni Arai
Objective: To present technique of minimally invasive coronary artery bypass grafting which we routinely use for total arterial revascularization in patients with multivessel coronary artery disease.
Case Video Summary: From July 2017 to September 2018 we operated on 21 non-selected consecutive patients with isolated multivessel coronary artery disease (male - 21 (100%). Mean age was 55.5 ± 9.2 years (range, 42 - 70). Mean weight - 93.1 ± 12.4 kg (range, 72 - 120), mean body mass index (BMI) - 30.7 ± 3.8 (range, 21.6 - 41.3). Left ventricle ejection fraction (LVEF) - 43.5 ± 3.2 % (range, 36- 65).Left anterior minithoracotomy (6-8 cm skin incision) was performed in the 4-th intercostal space. Peripheral cannulation was used for cardio-pulmonary bypass (CPB). Chiwood clamp was introduced through the 2ndintercostal space and cold blood antegrade intermittent cardioplegia was used every 15 minutes. Heart strings, encircling tapes, pulling the chitwood clamp and positive end-expiratory pressure in the right lung were used to improve the exposure of coronary targets. Average distance from skin to coronary targets was 6 cm (range, 4 - 9). Usual coronary instruments were used to perform coronary anastomoses. The mean number of grafts was 3.3 ± 0.85 (range, 2 - 5). Left internal mammary artery was used as conduit in 21 (100%) patients, right internal mammary artery - in 1 (4,8%), radial artery - in 20 (95,2%). The total operation time was 280 ± 31.7 minutes (range, 210 - 325), CPB time was 145 ± 23.2 (range, 120 - 187) minutes, aortic cross clamp time was 84.1 ± 19.9 (range, 45 - 118) minutes. The mean stays in intensive care unit was 2.35 ± 0.59 (range, 2-4) days. The mean total hospital stay was 6.1 ± 1.2 (range, 4 - 8) days. There were no mortality, no perioperative myocardial infarcts, no conversion to sternotomy.
Conclusions: Total coronary revascularization via left anterior thoracotomy using arterial conduits is safe and effective technique of minimally invasive coronary artery bypass grafting. This method could be routinely applied regardless number of grafts, quality and location of coronary targets, age.