ABSTRACT
BACKGROUND: The aim of this retrospective study was to evaluate the clinical outcome of three different minimally invasive surgical techniques for left anterior descending (LAD) coronary artery bypass grafting (CABG): Port-Access surgery (PA-CABG), minimally invasive direct CABG (MIDCAB) and off-pump totally endoscopic CABG (TECAB). METHODS: Over a decade, 160 eligible patients for elective LAD bypass were referred to one of the three techniques: 48 PA-CABG, 53 MIDCAB and 59 TECAB. In MIDCAB group, Euroscore was higher and target vessel quality was worse. In TECAB group, early patency was systematically evaluated using coronary CT scan. During follow-up (mean 2.7 ± 0.1 years, cumulated 438 years) symptom-based angiography was performed. RESULTS: There was no conversion from off-pump to on-pump procedure or to sternotomy approach. In TECAB group, there was one hospital cardiac death (1.7%), reoperation for bleeding was higher (8.5% vs 3.7% in MIDCAB and 2% in PA-CABG) and 3-month LAD reintervention was significantly higher (10% vs 1.8% in MIDCAB and 0% in PA-CABG). There was no difference between MIDCAB and PA-CABG groups. During follow-up, symptom-based angiography (n = 12) demonstrated a good patency of LAD bypass in all groups and 4 patients underwent a no LAD reintervention. At 3 years, there was no difference in survival; 3-year angina-free survival and reintervention-free survival were significantly lower in TECAB group (TECAB, 85 ± 12%, 88 ± 8%; MIDCAB, 100%, 98 ± 5%; PA-CABG, 94 ± 8%, 100%; respectively). CONCLUSIONS: Our study confirmed that minimally invasive LAD grafting was safe and effective. TECAB is associated with a higher rate of early bypass failure and reintervention. MIDCAB is still the most reliable surgical technique for isolated LAD grafting and the least cost effective.
Subject(s)
Coronary Artery Bypass/methods , Coronary Artery Disease/surgery , Coronary Vessels/surgery , Endoscopy/methods , Minimally Invasive Surgical Procedures/methods , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Robotics , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Cardiac Surgical Procedures/instrumentation , Heart Valve Diseases/surgery , Mitral Valve/surgery , Surgical Instruments , Aged , Equipment Design , Female , France , Heart Atria/surgery , Heart Valve Prosthesis Implantation/instrumentation , Humans , Male , Materials Testing , Middle Aged , Minimally Invasive Surgical Procedures , Prospective Studies , Treatment OutcomeABSTRACT
We describe the case of a 65-year-old man who presented with a false aneurysm of the right aortic coronary sinus, discovered after a routine medical examination. A complete resection of the aortic root and a reimplantation technique were performed. Herein, we describe the technical approach and immediate follow-up.
Subject(s)
Aneurysm, False/surgery , Aortic Aneurysm/surgery , Aortic Valve/surgery , Cardiac Surgical Procedures , Replantation , Sinus of Valsalva/surgery , Aged , Aneurysm, False/diagnostic imaging , Aortic Aneurysm/diagnostic imaging , Humans , Male , Sinus of Valsalva/diagnostic imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
As a ventricular unloading catheter, the Impella Recover LP 5.0 (Abiomed, Danvers, MA) is appropriate for temporary circulatory assistance in severe left ventricular dysfunction. We describe a new implantation approach to the right axillary artery with the aims of avoiding vascular problems due to atherosclerosis of the peripheral arteries and improving patient mobility and rehabilitation during mechanical support.
Subject(s)
Axillary Artery , Intra-Aortic Balloon Pumping/instrumentation , Shock, Cardiogenic/surgery , Ventricular Dysfunction, Left/complications , Adult , Cardiac Output, Low , Critical Illness , Equipment Design , Equipment Safety , Follow-Up Studies , Heart Transplantation , Heart-Assist Devices , Humans , Male , Middle Aged , Quality of Life , Shock, Cardiogenic/etiology , Treatment Outcome , Ventricular Dysfunction, Left/diagnosis , Waiting ListsABSTRACT
A 50-year-old man with an end-stage cardiac failure was referred to our institution for pre-transplantation assessment. An infrarenal aortic aneurysm (diameter 45 mm) was discovered and progressed (up to 59 mm) over a two-month period. Decision to perform aneurysmectomy with the support of an Impella Recover LP50 microaxial blood pump was decided regarding the rapid evolution of the disease. The patient had uneventful cardiac-wise during surgery and postoperative period.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Heart Failure/surgery , Heart-Assist Devices , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/physiopathology , Heart Failure/complications , Heart Failure/physiopathology , Hemodynamics , Humans , Male , Middle Aged , Treatment OutcomeSubject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation/methods , Catheterization, Central Venous/methods , Acute Disease , Aged , Aortic Dissection/diagnostic imaging , Aortic Dissection/mortality , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/mortality , Axillary Artery , Catheterization, Peripheral/methods , Female , Femoral Artery , Humans , Male , Middle Aged , Probability , Radiography , Risk Assessment , Survival Rate , Treatment OutcomeABSTRACT
INTRODUCTION: Primary spontaneous coronary artery dissection (PSCAD) is an uncommon cause of acute myocardial infarction that can lead to fatal course especially because of non-standardized management. We report the case of a 37-year-old woman who presented with a PSCAD of the right coronary artery. PATIENT: A young woman was addressed to our hospital for a PSCAD of the right coronary artery (RCA). During the coronary angiogram, an iatrogenous type II aortic dissection occurred. She was then scheduled for surgery since ascending aortic diameter after the dissection was measured at 52 mm. METHOD: A David procedure was made to replace the aortic root. Since weaning from cardiopulmonary bypass (CPB) was easy without ischemic signs in the right territory, we didn't systematically graft the RCA. Thirty minutes after the end of the procedure, a cardiogenic shock occurred witnessing a complete thrombosis of the RCA. CPB was restarted and the RCA was grafted on-pump using a right internal thoracic artery (RITA). The left network was examined and also showed to be dissected. Using the LITA, a T-graft was constructed and the left anterior descending and a marginal branch were grafted, rendering the weaning from CPB possible. RESULT: Postoperative troponin at day 1 was 93 microg/l. Weaning from inotropic drugs and from intra-aortic balloon pump was possible after four days. Extubation was postponed because of a pulmonary infection due to hemophilus influenzae. It was done at day 14. Echographic control showed no residual aortic insufficiency. CT-scan showed a patent RITA-to-RCA graft but an involution of the LITA graft, along with a healing of the left network. CONCLUSION: PSCAD is a severe condition and its management is unclear. The grafting of the diseased coronaries can be facilitated by an on-pump technique and the use of a coronary shunt to avoid further ischemia.
