Minimally invasive coronary artery bypass grafting using the inferior J-shaped ministernotomy in high-risk patients.
In the last years the population of patients referred for coronary surgery has changed toward a high-risk profile. In selected cases minimally invasive approach could be a good option to reduce mortality and morbidity. Between September 2005 and September 2007, twenty-one consecutive patients underwent minimally invasive bypass surgery using the J-shaped inferior mini-sternotomy approach. All patients had a EuroSCORE higher than 6. The operative mortality was 0%. Conversion to on-pump surgery was not necessary. The mean operation time was 89+/-18 min, the mean ventilation time was 2.4+/-2.2 h, the mean intensive care unit stay was 47.2+/-36.5 h. In four patients a hybrid approach to achieve a complete revascularization was used. After six months from the operation the graft patency was evaluated with the 64-slice computed tomography. In high-risk coronary patients the use of the minimally invasive technique appeared a good option to achieve low morbidity and mortality. Through a mini-sternotomy approach, single- or double-vessel revascularization can be performed safely off-pump even in high-risk patients without compromising the accuracy of the anastomosis. Nevertheless, a further investigation is required to evaluate the long-term results in a larger cohort of patients.
Del Giglio
Mauro
M
Department of Cardiovascular Surgery, Villa Maria Cecilia Hospital, V. Corriera 1, Cotignola, Lugo (RA), Italy.
Dell'Amore
Andrea
A
Aquino
Tommaso
T
Calvi
Simone
S
Calli
Morena
M
Marri
Claudio
C
Boni
Francesco
F
Lamarra
Mauro
M
D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D018579:Patient Selection; D018570:Risk Assessment; D012720:Severity of Illness Index; D013249:Sternum / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency