Effect of posterior pericardiotomy on atrial fibrillation in minimally invasive direct coronary artery bypass surgery.

Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques.

MIDCAB vs Conventional Surgery

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High thoracic epidural anesthesia as the sole anesthetic for redo off-pump coronary artery bypass surgery

To describe a rare complication of minimally invasive coronary artery bypass surgery. Case report. We present a 72-year-old patient with a left anterior descending artery stenosis who underwent elective minimally invasive direct coronary artery bypass (MIDCAB) surgery. Three months post-operatively he developed an anterior chest wall haematoma with electrocardiographic and enzyme evidence of myocardial ischaemia, though without haemodynamic embarrassment. Surgical exploration revealed non-anastomotic avulsion of the LIMA graft, which was bleeding freely into the left hemithorax. Minimally invasive direct coronary artery bypass surgery is now widely practised. Post-operative interruption of the left internal mammary artery graft is uncommon and avulsion of the graft proximal to the anastomosis with the left anterior descending artery has only been described in the literature on three occasions. This complication has been reported once in the setting of conventional bypass surgery and twice in the setting of minimally invasive direct coronary artery bypass surgery. In all of these cases, abrupt graft failure resulted in significant haemodynamic and/or ischaemic compromise, and all occurred within two weeks of surgery. Clinicians should be reminded of this rare though potentially catastrophic complication of MIDCAB surgery.

Introduction: The objective of this study was to analyze the blood transfusion factors of minimally invasive direct coronary artery bypass (MIDCAB) surgery using artificial intelligence. Methods: A retrospective analysis was performed for patients undergoing MIDCAB operations and no heart-lung machine was used from January 2017 to September 2022 in our hospital. The influencing factors of blood transfusion were used to build the artificial intelligence model. Eighty percent of the database was used as the training set, and twenty percent database was used as the testing set. To predict whether to use red blood cells during operation, we compared 104 artificial intelligence models. We aimed to assess whether which factors influence allogeneic transfusion in MIDCAB operations. Results: Of the 104 machine learning algorithms, the XGBoost model delivered the best performance, with an AUC of 0.726 in the testing set and an accuracy of 0.854 in the testing set. The artificial intelligence model showed preoperative hemoglobin less than 120 g/L, prothrombin time greater than 13.75, body mass index less than 22.7 kg/m2, coronary heart disease with additional comorbidities, a history of percutaneous coronary intervention, weight lower than 67 kg were the six major risk factors of allogeneic transfusion. Conclusion: The XGBoost model can predict transfusion or not transfusion in MIDCBA surgery with high accuracy. Introduction: The objective of this study was to analyze the blood transfusion factors of minimally invasive direct coronary artery bypass (MIDCAB) surgery using artificial intelligence. Methods: A retrospective analysis was performed for patients undergoing MIDCAB operations and no heart-lung machine was used from January 2017 to September 2022 in our hospital. The influencing factors of blood transfusion were used to build the artificial intelligence model. Eighty percent of the database was used as the training set, and twenty percent database was used as the testing set. To predict whether to use red blood cells during operation, we compared 104 artificial intelligence models. We aimed to assess whether which factors influence allogeneic transfusion in MIDCAB operations. Results: Of the 104 machine learning algorithms, the XGBoost model delivered the best performance, with an AUC of 0.726 in the testing set and an accuracy of 0.854 in the testing set. The artificial intelligence model showed preoperative hemoglobin less than 120 g/L, prothrombin time greater than 13.75, body mass index less than 22.7 kg/m2, coronary heart disease with additional comorbidities, a history of percutaneous coronary intervention, weight lower than 67 kg were the six major risk factors of allogeneic transfusion. Conclusion: The XGBoost model can predict transfusion or not transfusion in MIDCBA surgery with high accuracy.

Comparative economic analyses of minimally invasive direct coronary artery bypass surgery

“To exist is to change, to change is to mature, to mature is to go on creating oneself endlessly.” Henri Bergson In a recent editorial, Bonchek and Ullyot1 raised concerns regarding minimally invasive coronary bypass surgery. Their purpose was to “stimulate discussion and debate,” and to that end, we wish to challenge several of their assertions. While we totally agree that unbridled enthusiasm with a blind eye toward critical analysis is dangerous, equally precarious is taking the stance that we have a perfect operation that cannot or should not be made better. We believe that we are at a strategic inflection point in cardiac surgery and are in danger of becoming obsolete. In the history of information systems, the typewriter made a valuable contribution; however, it subsequently was made obsolete by computers. Although there is no question that coronary artery bypass surgery has changed the management of coronary artery disease dramatically, we need to realize that we are in the field of coronary revascularization and not just coronary artery surgery. Incremental progress, carefully measured, documented, and reported, should be encouraged rather than always accepting the status quo. The authors begin by limiting the obvious successes of minimally invasive surgery to technically simple operations that require “a minimum of precision and almost no sewing.” Our colleagues in general surgery would most likely disagree that their successes in laparoscopic Nissen procedures and inguinal hernia repairs were not precise and did not requiring sewing. Although cardiac operations are technically more complex, this does not mean that we should ignore the principles, techniques, and enabling technology developed from technically simpler operations and extend them to more complex procedures. Is this not the nature of evolution? The authors relate their own experience of isolated internal mammary artery (IMA)–to–left anterior descending coronary artery (LAD) grafting …

Intrathecal Morphine in Patients Undergoing Minimally Invasive Direct Coronary Artery Bypass Surgery

Twenty-year outcomes of minimally invasive direct coronary artery bypass surgery: The Leipzig experience

534 Robotically assisted MIDCAB surgery may have similarly favourable outcomes in high risk and low risk patients

Most patients undergoing minimally invasive direct coronary artery bypass surgery can be awakened and tracheally extubated in the operating room. We have compared two techniques of total IV anesthesia in this patient population: 30 patients (aged 44 to 74 yr; 24 male) premedicated with temazepam were randomly assigned to receive either remifentanil-propofol or alfentanil-propofol. Anesthesia was induced with remifentanil 2 microg/kg or with alfentanil 40 microg/kg, with propofol, and maintained with remifentanil at 0.25 or 0.5 microg x kg(-1) x min(-1) or alfentanil at 0.5 or 1 microg x kg(-1) x min(-1). The stable maintenance infusion rate of propofol was adjusted for age. Times to awakening and tracheal extubation were recorded. Postoperatively, IV morphine provided by patient-controlled analgesia was used for 48 h. Times to awakening and tracheal extubation (mean +/- SD) were shorter (P < 0. 01) in patients receiving remifentanil, and interpatient variations in times to awakening and tracheal extubation smaller (awakening 25 +/- 7 vs 74 +/- 32 min, and extubation 27 +/- 7 vs 77 +/- 32 min). Analysis of variance revealed that postoperative consumption of morphine was dependent on both the intraoperative opioid and the time elapsed after surgery (P < 0.05): patient-controlled analgesia morphine use during the first 3 h after awakening was more in patients receiving remifentanil (P < 0.01). Recovery of patients undergoing Minimally Invasive Direct Coronary Artery Bypass Surgery is significantly shorter and more predictable after total IV anesthesia with remifentanil-propofol than with alfentanil-propofol, which may be important if the goal is that patients will be awakened and tracheally extubated in the operating room.

The primary objective was to investigate the long-term survival of patients who underwent single-vessel coronary revascularization with minimally invasive direct coronary artery bypass surgery with or without hybrid revascularization. The secondary outcome measures were repeat revascularization either by coronary artery bypass grafting or by percutaneous coronary intervention and the incidence of myocardial infarction or recurrent angina. This is a retrospective study of prospectively collected data of patients who underwent minimally invasive direct coronary artery bypass procedure in our center between January 2001 and December 2015. Procedures were performed either through small left anterolateral thoracotomy or lower midline sternotomy. A total of 182 patients were identified: 100 underwent minimally invasive direct coronary artery bypass to the left anterior descending artery and 82 underwent hybrid revascularization (percutaneous coronary intervention to coronary arteries other than the left anterior descending artery along with minimally invasive direct coronary artery bypass to the left anterior descending artery). The mean ± SD age was 62 ± 10.1 years. Preoperatively 82% were male, and 72.5% patients had good left ventricular function. The median follow-up period was 10.9 years. There was no in-hospital or 30-day mortality. The 10-year actuarial survival was 84.8%. Freedom from repeat revascularization was 98.9% at 1 year and 89.9% at 10 years. At follow-up, freedom from myocardial infarction was 96.7% whereas freedom from angina was 92.9%. Within the limitations imposed by retrospective analyses, our study demonstrates excellent long-term outcome in patients undergoing minimally invasive direct coronary artery bypass with or without hybrid revascularization. For isolated left anterior descending artery disease minimally invasive direct coronary artery bypass should be considered, whereas hybrid revascularization (percutaneous coronary intervention and minimally invasive direct coronary artery bypass) should be considered for multivessel disease.

Assessment of minimally invasive direct coronary artery bypass grafting of the left internal thoracic artery by means of magnetic resonance imaging

Atrial fibrillation after minimally invasive direct coronary artery bypass surgery