Study of outcome of Minimal-access Off-pump multi-vessel CABG Using Bilateral Internal Thoracic Arteries
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 5
Abstract
Introduction: Usage of Bilateral Internal Thoracic arteries (BITA) in CABG has shown excellent long term survival and a very low rate of reintervention. The use of BITA in patients with diabetes has been a matter of debate because of the risk of sternal wound infection. A multivessel minimally invasive off pump CABG technique has been developed using BITA through a sternal sparing approach. Material and Methods: Over a period of 5 years from August 2011 to August 2016, off pump minimally invasive multivessel CABG using BITAs was performed on 819 patients through a 2 inch left minithoracotomy incision. The complete revascularization of the myocardium was done using the LITARITA Y composite conduit. Coronary artery stabilization for anastomoses was done by using epicardial stabilizers introduced through the minithoracotomy. Results: 819 patients comprising of 753 (92%) diabetics, had minimally invasive total arterial myocardial revascularization using BITAS (LITA - RITA Y composite conduit) via a left minithoracotomy. 171 (21%) patients had 4 grafts and 557 (68%) had 3 grafts with an average number of grafts of 3.1. Ejection Fraction was 40.5 +/- 5.2%. 6 (0.7%) patients died and 5 (0.6%) had to be re-explored for bleeding. In 4 (0.4%) cases we opted for an early elective conversion to sternotomy due to hemodynamic instability. The harvesting time for RITA and LITA were 28.5+/- 10.2 and 22.2 +/-7.6.minutes respectively. The overall operating time was 175.8+/-21.6 min. 651 patients (79%) were extubated in the operating room (OR). The total time in the OR (including extubation) was 295.5+/- 32.5 minutes. Most of the patient were discharged on third postoperative day. During follow up at 12 month, graft patency was assessed using Coronary angiograms in 195 (23%), CT angiograms in 172 (21%) patients. All these grafts were patent. 284 patients (34%) had normal stress test. Reintervention angioplasty was needed in 4 patients (0.4%). Conclusions: The early outcomes of Minimal access OPCAB using BIMA have been good and coronary angiograms showed widely patent grafts. This technique is a safe and reproducible option in coronary artery bypass grafting. It is less invasive and offers safe usage of bilateral internal thoracic arteries with its associated benefits, without related complications of a median sternotomy, especially in diabetics.
Authors and Affiliations
Sanjay Kumar, Pradeep Nambiar
Keywords
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