Minimally Invasive Coronary Surgery as a primary strategy for reoperative myocardial revascularization.

Artak Kazaryan, Igor U. Sigaev , Maksim V. Starostin , Beka D. Morchadze, Ivan V. Pilipenko , Afanasi A. Nazarov , Ekaterina A. Kolesnikova , Petr V. Gusev , Edgar C. Beglaryan

Bakoulev National Medical Research Centre for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – C

Abstract

Background. Redo CABG in patients with one or two vessel disease, contraindications to sternotomy or central cardiopulmonary bypass (CPB) presents a technical challenge. In this study we reviewed patient selection, operative technique, and early results in patients having redo-CABG to the LAD, circumflex artery ore RCA system by a thoracotomy with / without CPB.

Methods. From January 2015 through November 2017, 19 patients with contraindications to conventional redo- CABG had target vessel revascularization by thoracotomy. Eleven patients had an anteriorthoracotomy for LAD or RCA revascularization, fore-anterolateralthoracotomy for LAD and CX revascularization, five- posterolateral thoracotomy for CX revascularization. There were 16 men and 3 women, aged 48-74(mean 63) years. Left ventricular systolic function as evaluated by preoperative echocardiography was from 42 to58 % (mean 48%). History of Myocardial infarctions had 15(79%) after CABG and PCI 19(100%)patients. The mean interval from the previous CABG was 89(6-192) months. Ninepatients(43%) had at least one patent ITA graft. Two patients reoperated for the significant stenosis distal to LITA to LAD anastomosis site. The LITA was re-used having anastomosed to the distal part of LAD. In other cases used saphenous vein grafts. In 6 cases we used peripheral CPB (20-129 min). The proximal anastomosis formed with descending aorta (12 patients), left and right subclavian artery (2 patients), old vein graft (1 patient). Complete revascularization was the goal in all patients. There was no hospital mortality, postoperative cardiac myocardial infarctions and need for intraaortic balloon pump support.

Conclusions:Reoperative MICS provides targeted coronary revascularization and avoids hazards of sternal re-entry, graft injury and manipulation.