Minimally invasive direct coronary artery bypass grafting with an improved rib spreader and a new-shaped cardiac stabilizer: results of 200 consecutive cases in a single institution.

Yunpeng Ling,Qing Gao,Liming Bao,Yu Chen,Wei Yang

doi:10.1186/s12872-016-0216-4

Abstract

BackgroundPerforming minimally invasive direct coronary artery bypass (MIDCAB) grafting via small chest incisions on a beating heart is challenging. We report our experiences of MIDCAB with the utilization of both an improved rib spreader to harvest the left internal mammary artery (LIMA) and a new-shaped cardiac stabilizer to facilitate LIMA-left anterior descending (LAD) coronary anastomosis.MethodsBetween May 2012 and June 2104, a total of 200 patients who were consecutively operated on in this period were enrolled in this study. Data reported included demographic information, preoperative clinical and cardiac status, LIMA harvest time, postoperative in-hospital outcomes, and 30-day mortality.ResultsThe average LIMA harvest time was 43 min. The mean age was 62.59 ± 10.19 years, and 45 of the 200 were females. The 30-day mortality was 0.5 % (one patient) due to perioperative myocardial infarction. Duration of mechanical ventilation and length of stay in intensive care unit was 9.27 ± 7.65 and 24.27 ± 17.85 h, respectively. The unit of packed RBC transfusion was 0.79 ± 1.58. Postoperative atrial fibrillation was observed in 14 (7 %) patients. There was no postoperative stroke, renal failure, or incision complication.ConclusionPerforming MIDCAB with the improved retractor and stabilizer utilized in this study showed favorable outcomes in terms of harvesting the LIMA, postoperative morbidities, and 30-day mortality.

Highlights

Performing minimally invasive direct coronary artery bypass (MIDCAB) grafting via small chest incisions on a beating heart is challenging
While Minimally invasive direct coronary artery bypass (MIDCAB) can lead to favorable outcomes, performing coronary anastomosis via a small chest incision on a beating heart can be challenging [5]
Data from our study suggest that MIDCAB procedures performed with the improved retractor and stabilizer had favorable outcomes

Summary

Introduction

Performing minimally invasive direct coronary artery bypass (MIDCAB) grafting via small chest incisions on a beating heart is challenging. Unlike conventional revascularization techniques, which are highly invasive due to the use of a large incision (sternotomy) and cardiopulmonary bypass (CPB), MIDCAB limits invasiveness by employing a small incision (thoracotomy) and by operating on the beating heart to avoid the need for CPB [1]. While MIDCAB can lead to favorable outcomes, performing coronary anastomosis via a small chest incision on a beating heart can be challenging [5]. This makes it difficult to accomplish two key aspects of the MIDCAB procedure. The first pertains to obtaining an adequate length of left internal mammary artery (LIMA) [6] and

Methods

Results

Conclusion