Off-pump Coronary Artery Bypass Grafting through Left-sided Thoracotomy in the Treatment of Patients with Coronary Artery Disease

Juriy Schneider , Victor Tsoy, Andrew Kotsiyenko, Pavel Shilenko

Federal State Budgetary Institution “Federal Center of High Medical Technolo-gy” of Ministry of Healthcare of the Russian Federation, Kaliningrad, Kaliningrad, Russia

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–C

Abstract

Introduction:To present our experience off-pump coronary artery bypass grafting (CABG) through the left-sided thoracotomy.

Materials and Methods: During the period from 09.2012 to 12.2017, in our center treated 496 patients with coronary artery diseasewho underwent CABG from left thoracotomy:352 men (71%) and 144 women (29%). Age 65.5 ±15.7 years; the number of diseased coronary arteries - 2.2.9 patients had a history of CABG, in7 cases using the left internal thoracic artery (LITA). Euroscore II5.7 ±4.2.Comorbidities- COPD, asthma, atherosclerosis, peripheral vascular disease, diabetes, obesity, CKD. Angina functional class- II-III, CHF - I-III of NYHA, EF36 ± 12.7%. All patients underwent off pump CABG of the left anterior descending (LAD): in178 patients with isolated LAD lesion, the rest as a stage hybrid intervention.In hybrid interventions the second stage were stenting 1 or 2 coronary arteries.In489 cases the LITA was used, in7 carried autovenous subclavian artery bypass surgery (LITAused in the previous surgery).

Results: 3 patients died in early postoperative period, the reason was acute cardiovascular failure. There were norepeated coronary artery bypass grafting.The average time spent in the hospital5,8 days. Re-thoracotomy was done in 7(1.4%) cases after postoperative bleeding(LITA bed).Infectious complications of the postoperative wound were observed in 5(1%) women with body mass index >35 withinsulin-dependent diabetes mellitus. In 4 cases was stenting circumflex arteryin the early postoperative period due to acute ischemic changes.Themeanintraoperativebloodloss - 150.0ml.

Conclusion:Off-pump coronary artery bypass grafting through the left-sided thoracotomy is a surgical method with less injury, short hospitalization time and fast recovery, which can be used as the isolated lesion of the left artery descending, and multivessel disease – as a stage of the hybrid intervention.