Invasive Myocardial Revascularization Research Articles

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ БОЛЬНЫХ ИБС СО СНИЖЕННОЙ СОКРАТИТЕЛЬНОЙ СПОСОБНОСТЬЮ МИОКАРДА ЛЕВОГО ЖЕЛУДОЧКА

The increased worldwide interest in performing coronary artery bypass grafting operations on a beating heart has made the question of the results of these operations in patients with low contractility of the left ventricular myocardium belonging to the high-risk category urgent. The aim of our study was a comparative assessment of the immediate results of surgical treatment of patients with reduced (LVEF <45%) and normal myocardial contractility, operated under MIRM conditions. Materials and methods. A comparative analysis of the immediate results of surgical treatment of 302 patients with coronary artery disease who underwent beating heart bypass surgery was carried out. Most of the patients were men (81.3%). The average age of the general group was 59.2 ± 7.4 years. The patients were divided into two groups - patients with LVEF less than 45% - 49 patients (16%) and patients with LVEF more than 45% - 253 people (84%). Results. Despite the fact that for a number of clinical indicators (concomitant diseases), we obtained a statistically significant difference - arterial hypertension, BCA lesion, mean LVEF, according to the main hemodynamic criteria, such as - unstable angina pectoris, middle class according to CCS and NYHA, the number of women in group, lesion of the trunk of the LCA and multivessel coronary artery disease, we did not reveal statistically significant differences between our groups. Nevertheless, the initial degree of operational risk according to EuroSCORE II was significantly higher in the first group of patients - with a low left ventricular ejection fraction. Conclusions. Our results of a comparative assessment of two groups of patients - with reduced LV ejection fraction (less than 45%) and with normal contractile ability, who underwent minimally invasive myocardial revascularization, showed the high efficiency of this type of surgical treatment.

Minimally Invasive Coronary Bypass Grafting as a Standard Approach for Myocardial Revascularization


 Background. Minimally invasive cardiac surgery is becoming more widespread.
 The aim of the study was to evaluate the outcomes in 343 consecutive patients with isolated multivessel coronary artery disease who underwent minimally invasive coronary revascularization.
 Materials and methods. From July 2017 to December 2019 we performed total coronary revascularization via left anterior minithoracotomy (TCRAT) in 343 consecutive patients with isolated multivessel coronary artery disease. In 83 (24.2%) of them we performed multiarterial revascularization using left internal mammary artery (LIMA) and T-shunt with left radial artery or right internal mammary artery (RIMA). Cardiopulmonary bypass (CPB), aortic cross-clamping and blood cardioplegia were used in all patients. The patients were divided into two groups, uniarterial and multiarterial, to compare and analyze perioperative parameters.
 Results. No cases of postoperative myocardial infarction, surgically induced infection, or conversion to sternotomy were observed in any of the study groups. Total perioperative mortality was 0.58% (2 patients). Total operation time (290.6±48 [205; 495] versus 259.4±53.3 [165; 590], p=0.0001) and aortic cross-clamping time (81.6±18.7 [40; 122] versus 67±18 [35; 146], p<0.0001) were longer in patients with multiarterial revascularization compared to those with uniarterial revascularization. The patient’s mean age in the multiarterial group was 7.4 years less than in the uniarterial group. The mean hospital stay was 0.5 days shorter in the multiarterial group.
 Conclusions. The technique of minimally invasive coronary artery bypass grafting via left anterior thoracotomy avoids median sternotomy in 97.7% of patients. Both strategies for minimally invasive myocardial revascularization (multiarterial and uniarterial) are safe and effective with comparable perioperative outcomes and a total mortality of 0.58%.

Immediate results of three methods of surgical myocardial revascularization in multivessel lesion of the coronary bed

Percutaneous coronary intervention (PTI) and coronary artery bypass grafting (CABG) are currently the most commonly used techniques of myocardial revascularization. However, each of the methods has its own advantages and disadvantages. The creation of hybrid coronary revascularization (HCR) was based on an attempt to combine the benefits of CABG and PTI. The study was aimed at assessing the immediate results of three methods of surgical myocardial revascularization in patients with multivessel lesions of the coronary bed in stable ischaemic heart disease. The study enrolled a total of 155 patients randomized into three groups of myocardial revascularization: HCR, CABG and PTI. In the HCR group, the first stage consisted in minimally invasive myocardial revascularization with the anterior descending artery (ADA) followed by PTI (within 1-3 days) with implantation of drug-eluting second-generation stents Xience to other coronary vessels. In the CABG and PTI groups we performed CABG and PTI, respectively, using the Xience stents. In all three groups we assessed the procedural success, frequency of major adverse cardiovascular events and bleeding. Full myocardial revascularization was achieved in all three groups in more than 90% of cases. No statistically significant differences in either the procedural success rate or frequency of major adverse cardiovascular events between the CABG, PTI and HCR were revealed. The PTI group was characterized by the lowest frequency of bleeding, need for rehabilitation, and length of hospital stay. Hybrid revascularization with the use of minimally invasive direct myocardial revascularization with the ADA followed by PTI with second-generation drug-eluting stents to other coronary arteries is a method of choice in treatment of patients with multivessel lesions of coronary arteries.

Minimally invasive coronary artery bypass grafting.

Minimally invasive cardiac surgery (MICS)-CABG is a technique that at its core has patient comfort, early return to routine activities, meeting patient expectations for less invasive options, and maintaining the highest possible standards of care and outcomes. The technique requires not only surgical dexterity but also integration of significant technological advancements in patient care. At a time when percutaneous interventions are often prescribed on the pretext of increased patient comfort and demand, minimally invasive myocardial revascularization becomes even more relevant. Minimally invasive myocardial revascularization is ever evolving and encompasses both small-incision open techniques as well as endoscopic-assisted procedures. The success of the procedure depends not only on the learning curve and familiarity with the technology but also on appropriate patient selection. Mere feasibility of the technique is not sufficient, and the results have to be comparable with the long-established techniques of conventional coronary artery bypass grafting both in terms of early morbidity and mortality as well as long-term outcomes. In this review, we discuss patient selection and technical aspects of minimally invasive coronary artery bypass grafting. We also provide an evidence-based comparison to early and long-term outcomes with conventional coronary artery bypass grafting. Finally, we review the uptake and outcomes of minimally invasive revascularization in the Indian subcontinent.

Малоинвазивная реваскуляризация миокарда в остром периоде инфаркта миокарда после осложненного стентирования правой коронарной артерии

Малоинвазивная реваскуляризация миокарда в остром периоде инфаркта миокарда после осложненного стентирования правой коронарной артерии

Малоинвазивная реваскуляризация миокарда у больного с атеросклерозом восходящего отдела аорты

Малоинвазивная реваскуляризация миокарда у больного с атеросклерозом восходящего отдела аорты

Hybrid minimally invasive myocardial revascularization in multivessel coronary disease . Current status of the issue

This article provides an overview of the literature on the issue of minimally invasive hybrid revascularization in patients with stable multivessel coronary artery disease. It is announced design of randomized study HREVS (Hybrid REvascularization Vs Surgery), to compare the results of myocardial revascularization using three strategies: 1) hybrid revascularization minimally invasive on pump coronary artery bypass surgery LIMA to LAD (MID CAB) and stenting of other coronary arteries using drug-eluting stents); 2) coronary artery bypass grafting with cardiopulmonary bypass; 3) multivessel coronary stenting with drug-eluting stents.

The dynamics of inflammatory factors in the early postoperative period after various techniques of coronary artery bypass grafting

It was analyzed the dynamics of inflammatory factors in patients with ischemic heart disease in early postoperative period who underwent various techniques of coronary artery bypass grafting (CABG). Seventy-four patients with ischemic heart disease who required CABG were enrolled into study. Patients were divided into 4 groups depending on technique and volume of surgery. The first group consisted of 7 patients after minimally invasive off-pump myocardial revascularization under normothermia without cardiopulmonary bypass (CPB) and cardioplegia. The second group (36 patients) enrolled patients after normothermic off-pump CABG and parallel CPB. The third group had 12 patients who underwent CABG under CPB, hypothermia (28oС) and pharmaco-cold cardioplegia. The 4 group consisted of 19 patients who were operated for ischemic heart disease and concomitant cardiac disorders (left ventricular postinfarction aneurysm, valve surgery) under CPB, hypothermia (28 oС) and pharmaco-cold cardioplegia. Levels of tumor necrosis factor, interleukins (IL-6, IL-8, IL-10) were identified using enzyme immunoassay. Blood sampling was performed preoperatively, in 6 hours and in 24 hours after surgery. Patients after CPB and cardioplegia had more severe systemic inflammatory response and debalance between proinflammatory and anti-inflammatory mediators in early postoperative period. It was revealed correlation between inflammatory cytokines and myocardial damage markers in early postoperative period with development of acute heart failure and multiple-organ failure: IL-8 (r=0.45, р=0.01; r=0.55, р=0.001); troponin I (r=0.65, р=0.0001; r=0.67, р=0.0001); МВ-creatine phosphokinase (r=0.58, р=0.0004; r=0.56, р=0.001). It was concluded that patients after CPB and cardioplegia need for prevention and correction of systemic inflammatory response. It will improve myocardial protection, decrease incidence of acute heart failure and other postoperative complications. Minimally invasive myocardial revascularization is preferable in patients with decreased left ventricular systolic function because of improvement of myocardial protection.

Сравнительный анализ результатов миниинвазивной реваскуляризации миокарда, коронарного шунтирования на работающем сердце и с искусственным кровообращением

Сравнительный анализ результатов миниинвазивной реваскуляризации миокарда, коронарного шунтирования на работающем сердце и с искусственным кровообращением

Harvesting bilateral internal thoracic arteries using a novel subxiphoid approach versus the conventional lateral thoracic approach—results of an experimental study

A new method was developed to harvest bilateral internal thoracic artery grafts using a subxiphoid approach and robotic assistance. The present study compared the potential utility of the subxiphoid method with that of the lateral thoracic approach. The first part of the study examined the optimal placement of the instrument ports to maximize the robotic arms' range of motion. The second part of the study examined the 2 approaches for harvesting bilateral internal thoracic arteries from pig carcasses. The obtained graft lengths and time needed to conduct each procedure were compared using the Mann-Whitney U test. The preliminary study suggested that optimal positioning of the instrument ports was achieved by placing the right and left instrument ports far apart and linearly arranging all the ports. Using this configuration, the subxiphoid approach yielded a left internal thoracic artery that was 11.7 ± 1.90 cm long compared with 9.17 ± 0.74 cm using the conventional approach (P=.0131). The right internal thoracic arteries (11.8 ± 1.69 cm) obtained using the subxiphoid approach were significantly longer than those obtained using the conventional approach (8.88 ± 0.58 cm). The time needed to harvest the right internal thoracic arteries (34.7 ± 8.14 minutes) was significantly shorter using the subxiphoid approach than using the conventional approach (52.3 ± 8.21 minutes). Because of the maximized lengths of the grafts and the duration of the procedure, therobot-assisted subxiphoid approach could be an effective method for performing minimally invasive myocardial revascularization in patients with multivessel disease.

Применение экстракорпорального кровообращения при миниинвазивной реваскуляризации миокарда

Применение экстракорпорального кровообращения при миниинвазивной реваскуляризации миокарда

106 Minimally invasive myocardial revascularization with robotic assistance

BackgroundMinimally invasive myocardial revascularization (MIDCAB) with robotic assistance consists in IMA harvesting with DaVinci robotic system, followed by direct coronary anastomosis through minithoracotomy. We report the experience of this technique at Hôpital du Sacré-Cœur de Montréal.Method/resultsCharts were reviewed for perioperative and follow-up data. From August 2006 to April 2011, 31 patients underwent MIDCAB with robotic assistance. Median age was 60, 34.8% were female, and median Parsonnet score was 3. All patients had ostial or very proximal lésion on LAD, not amenable to percutaneous revascularization. The LIMA was harvested in all cases ; in two patients, RIMA was also harvested. There was three cases of hybrid revascularization, in which MIDCAB surgery was followed by PCI on either the right or the circumflex system. Conversion to standard offpump open technique happened in 3 cases. Reasons for conversion were ventricular arythmia secondary to hypothermia, bleeding at trocart insertion, and LIMA friability. None of these patients had any other operative complication. Median operative time was 188 minutes. There was no perioperative MI, CVA or mortality. Median post operative stay was 4 days. All patients, except one had clinical follow-up with exercise stress test ; médian follow-up time is 23 months. There was one repeat revascularization on LAD by PCI; the LIMA was found to be patent, but of small caliber. All patients demonstrated good functionnal class (median NYHA 1).ConclusionMinimally invasive myocardial revascularization (MIDCAB) with robotic assistance is safe and represent an alternative to PCI when the LAD lesion is not amenable to the latter. BackgroundMinimally invasive myocardial revascularization (MIDCAB) with robotic assistance consists in IMA harvesting with DaVinci robotic system, followed by direct coronary anastomosis through minithoracotomy. We report the experience of this technique at Hôpital du Sacré-Cœur de Montréal. Minimally invasive myocardial revascularization (MIDCAB) with robotic assistance consists in IMA harvesting with DaVinci robotic system, followed by direct coronary anastomosis through minithoracotomy. We report the experience of this technique at Hôpital du Sacré-Cœur de Montréal. Method/resultsCharts were reviewed for perioperative and follow-up data. From August 2006 to April 2011, 31 patients underwent MIDCAB with robotic assistance. Median age was 60, 34.8% were female, and median Parsonnet score was 3. All patients had ostial or very proximal lésion on LAD, not amenable to percutaneous revascularization. The LIMA was harvested in all cases ; in two patients, RIMA was also harvested. There was three cases of hybrid revascularization, in which MIDCAB surgery was followed by PCI on either the right or the circumflex system. Conversion to standard offpump open technique happened in 3 cases. Reasons for conversion were ventricular arythmia secondary to hypothermia, bleeding at trocart insertion, and LIMA friability. None of these patients had any other operative complication. Median operative time was 188 minutes. There was no perioperative MI, CVA or mortality. Median post operative stay was 4 days. All patients, except one had clinical follow-up with exercise stress test ; médian follow-up time is 23 months. There was one repeat revascularization on LAD by PCI; the LIMA was found to be patent, but of small caliber. All patients demonstrated good functionnal class (median NYHA 1). Charts were reviewed for perioperative and follow-up data. From August 2006 to April 2011, 31 patients underwent MIDCAB with robotic assistance. Median age was 60, 34.8% were female, and median Parsonnet score was 3. All patients had ostial or very proximal lésion on LAD, not amenable to percutaneous revascularization. The LIMA was harvested in all cases ; in two patients, RIMA was also harvested. There was three cases of hybrid revascularization, in which MIDCAB surgery was followed by PCI on either the right or the circumflex system. Conversion to standard offpump open technique happened in 3 cases. Reasons for conversion were ventricular arythmia secondary to hypothermia, bleeding at trocart insertion, and LIMA friability. None of these patients had any other operative complication. Median operative time was 188 minutes. There was no perioperative MI, CVA or mortality. Median post operative stay was 4 days. All patients, except one had clinical follow-up with exercise stress test ; médian follow-up time is 23 months. There was one repeat revascularization on LAD by PCI; the LIMA was found to be patent, but of small caliber. All patients demonstrated good functionnal class (median NYHA 1). ConclusionMinimally invasive myocardial revascularization (MIDCAB) with robotic assistance is safe and represent an alternative to PCI when the LAD lesion is not amenable to the latter. Minimally invasive myocardial revascularization (MIDCAB) with robotic assistance is safe and represent an alternative to PCI when the LAD lesion is not amenable to the latter.

Anesthetic Management of a Patient Undergoing Minimally Invasive Myocardial Revascularization Before Lung Transplantation

Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio

The future of minimally invasive myocardial revascularization: a surgeon's view.

The future of minimally invasive myocardial revascularization: a surgeon's view.

The future of minimally invasive myocardial revascularization: a cardiologist's view.

The future of minimally invasive myocardial revascularization: a cardiologist's view.

Anesthetic Management of a Patient Undergoing Minimally Invasive Myocardial Revascularization Before Lung Transplantation

Anesthetic Management of a Patient Undergoing Minimally Invasive Myocardial Revascularization Before Lung Transplantation

Lesions of the Target Vessel During Minimally Invasive Myocardial Revascularization

Minimally invasive coronary artery bypass grafting has recently been introduced into cardiac surgery. In this report we discuss the incidence of surgically induced distal target vessel stenosis in patients who undergo the minimally invasive coronary artery bypass grafting procedure, which represents a major drawback of the procedure in our experience. Doppler evaluation of mammary artery flow was performed postoperatively in all 55 patients who underwent minimally invasive coronary artery bypass grafting at our institution. Angiography was performed in the first 35 consecutive patients for control purposes and in 2 patients who complained of angina recurrence. In 32 of the first 35 consecutive patients, the anastomosis was found to be functioning normally and the distal left anterior descending artery was normal; in the remaining 3 patients we found mammary artery occlusion, anastomotic stenosis, and stenosis of the anastomosis and the distal left anterior descending artery in 1 patient each. A distal left anterior descending artery stenosis was found in the only 2 patients who underwent late angiography. Surgically induced distal target vessel stenosis represents a major drawback of minimally invasive coronary artery bypass grafting in our experience. Further improvement in the means of achieving coronary artery occlusion, as well as in anticoagulant and antiplatelet therapy, is mandatory before minimally invasive coronary artery bypass grafting can be confidently accepted into clinical practice.

Revascularização do miocárdio minimamente invasiva

OBJETIVO: Tendência atual em todas as áreas da cirurgia aponta para táticas e técnicas cirúrgicas que tornem o ato operatório cada vez menos invasivo. O objetivo do presente estudo foi avaliar a viabilidade da revascularização do miocárdio através de mínima incisão torácica (minitoracotomia esquerda), sem circulação extracorpórea. CASUÍSTICA E MÉTODOS: De setembro de 1995 a março de 1996, um total de 19 pacientes portadores de lesões isoladas do ramo interventricular anterior (RIA) e/ou diagonal (Dg) foram submetidos a revascularização do miocárdio, tendo, como via de acesso, toracotomia anterior paraesternal esquerda, de aproximadamente 7 cm de extensão, ao nível do 4º espaço intercostal. Através dessa incisão foi dissecada a artéria torácica interna esquerda (ATIE) em extensão suficiente para a realização da anastomose com o RIA efetuada sem circulação extracorpórea. No 2º dia de pós-operatório esses pacientes foram submetidos a arteriografia e eco-Doppler transtorácico da ATIE para verificação das condições do enxerto e da persistência de fluxo pelos ramos intercostais não ligados por ocasião da dissecção parcial da artéria. RESULTADOS: Todos os pacientes tiveram boa evolução pós-operatória. O resultado da ATIE realizado em 16 dos 19 pacientes operados mostrou padrões angiográficos excelentes em 13 deles. Não se demonstrou contrastação dos ramos intercostais não ligados durante a dissecção. O Doppler transtorácico se correlacionou com as condições dos enxertos. CONCLUSÃO: Os resultados iniciais obtidos na revascularização do miocárdio através de minitoracotomia esquerda sugerem ser esta uma boa alternativa tática para portadores de lesão isolada do RIA com excelente resultado estético.