Immediate results of minimally invasive redo off-pump coronary artery bypass grafting

Coronary heart disease (CHD) ranks first among the causes of death from cardiac events. Patients who have previously undergone surgical treatment – coronary artery bypass grafting (CABG) – are not immune from the return of angina due to the progression of atherosclerosis in the native coronary arter...

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Autores principales:	V. A. Podkamenniy, A. A. Sharavin, D. I. Likhandi, Yu. V. Zheltovsky, A. V. Vyrupaev
Formato:	article
Lenguaje:	RU
Publicado:	Scientific Сentre for Family Health and Human Reproduction Problems 2021
Materias:	minimally invasive surgery off-pump coronary artery bypass grafting redo surgery artificial blood circulation sternotomy Science Q
Acceso en línea:	https://doaj.org/article/aa201e8af4614c48886f643668d1d52f
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spelling	oai:doaj.org-article:aa201e8af4614c48886f643668d1d52f2021-11-23T06:14:47ZImmediate results of minimally invasive redo off-pump coronary artery bypass grafting2541-94202587-959610.29413/ABS.2021-6.5.21https://doaj.org/article/aa201e8af4614c48886f643668d1d52f2021-11-01T00:00:00Zhttps://www.actabiomedica.ru/jour/article/view/3053https://doaj.org/toc/2541-9420https://doaj.org/toc/2587-9596Coronary heart disease (CHD) ranks first among the causes of death from cardiac events. Patients who have previously undergone surgical treatment – coronary artery bypass grafting (CABG) – are not immune from the return of angina due to the progression of atherosclerosis in the native coronary arteries or degenerative changes in the shunts. Therefore, the issue of redo surgery in this group of patients is debatable.The aim of the research is to show that the use of alternative sternotomy approaches and the rejection of artificial blood circulation (ABC) are considered as possible measures to improve the results of redo CABGs.Materials and methods. In the Cardiac Surgery Unit No. 1 of the Irkutsk Regional Clinical Hospital from 2003 to 2020, 6773 off-pump CABG surgeries were performed. Of these, 6338 (93.6 %) surgeries were performed using median sternotomy and 435 (6.4 %) surgeries were performed using minitoracotomy or subxyphoid access. Of the 6338 CABG surgeries performed using sternotomy, 58 (0.9 %) were performed repeatedly. All redo surgeries during the period under review were performed by minithoracotomy or subxyphoid access. The indication for redo surgery was the return of angina of III or IV functional class, which did not respond to optimal drug therapy. When performing 54 redo surgeries, the access was leftsided mini-thoracotomy. In 3 patients, CABG was performed by subxyphoid access and in 1 patient – from right-sided mini-thoracotomy.Results. 58 redo CABG surgeries were performed. There was no damage to the access of the heart or functioning shunts. Complications were noted in 5 (8.6 %) patients. In 1 case, a second operation was required due to bleeding from the intercostal artery. In other cases, there were rhythm disturbances, or the need for inotropic support.Conclusion. Performing redo off-pump CABG surgeries using mini-accesses reduces the risk of damage to the heart and functioning shunts, eliminates manipulations on the ascending aorta, and avoids difficulties with cardioplegic protection of the myocardium with a functioning mammarocoronary graft.V. A. PodkamenniyA. A. SharavinD. I. LikhandiYu. V. ZheltovskyA. V. VyrupaevScientific Сentre for Family Health and Human Reproduction Problemsarticleminimally invasive surgeryoff-pump coronary artery bypass graftingredo surgeryartificial blood circulationsternotomyScienceQRUActa Biomedica Scientifica, Vol 6, Iss 5, Pp 222-229 (2021)
institution	DOAJ
collection	DOAJ
language	RU
topic	minimally invasive surgery off-pump coronary artery bypass grafting redo surgery artificial blood circulation sternotomy Science Q
spellingShingle	minimally invasive surgery off-pump coronary artery bypass grafting redo surgery artificial blood circulation sternotomy Science Q V. A. Podkamenniy A. A. Sharavin D. I. Likhandi Yu. V. Zheltovsky A. V. Vyrupaev Immediate results of minimally invasive redo off-pump coronary artery bypass grafting
description	Coronary heart disease (CHD) ranks first among the causes of death from cardiac events. Patients who have previously undergone surgical treatment – coronary artery bypass grafting (CABG) – are not immune from the return of angina due to the progression of atherosclerosis in the native coronary arteries or degenerative changes in the shunts. Therefore, the issue of redo surgery in this group of patients is debatable.The aim of the research is to show that the use of alternative sternotomy approaches and the rejection of artificial blood circulation (ABC) are considered as possible measures to improve the results of redo CABGs.Materials and methods. In the Cardiac Surgery Unit No. 1 of the Irkutsk Regional Clinical Hospital from 2003 to 2020, 6773 off-pump CABG surgeries were performed. Of these, 6338 (93.6 %) surgeries were performed using median sternotomy and 435 (6.4 %) surgeries were performed using minitoracotomy or subxyphoid access. Of the 6338 CABG surgeries performed using sternotomy, 58 (0.9 %) were performed repeatedly. All redo surgeries during the period under review were performed by minithoracotomy or subxyphoid access. The indication for redo surgery was the return of angina of III or IV functional class, which did not respond to optimal drug therapy. When performing 54 redo surgeries, the access was leftsided mini-thoracotomy. In 3 patients, CABG was performed by subxyphoid access and in 1 patient – from right-sided mini-thoracotomy.Results. 58 redo CABG surgeries were performed. There was no damage to the access of the heart or functioning shunts. Complications were noted in 5 (8.6 %) patients. In 1 case, a second operation was required due to bleeding from the intercostal artery. In other cases, there were rhythm disturbances, or the need for inotropic support.Conclusion. Performing redo off-pump CABG surgeries using mini-accesses reduces the risk of damage to the heart and functioning shunts, eliminates manipulations on the ascending aorta, and avoids difficulties with cardioplegic protection of the myocardium with a functioning mammarocoronary graft.
format	article
author	V. A. Podkamenniy A. A. Sharavin D. I. Likhandi Yu. V. Zheltovsky A. V. Vyrupaev
author_facet	V. A. Podkamenniy A. A. Sharavin D. I. Likhandi Yu. V. Zheltovsky A. V. Vyrupaev
author_sort	V. A. Podkamenniy
title	Immediate results of minimally invasive redo off-pump coronary artery bypass grafting
title_short	Immediate results of minimally invasive redo off-pump coronary artery bypass grafting
title_full	Immediate results of minimally invasive redo off-pump coronary artery bypass grafting
title_fullStr	Immediate results of minimally invasive redo off-pump coronary artery bypass grafting
title_full_unstemmed	Immediate results of minimally invasive redo off-pump coronary artery bypass grafting
title_sort	immediate results of minimally invasive redo off-pump coronary artery bypass grafting
publisher	Scientific Сentre for Family Health and Human Reproduction Problems
publishDate	2021
url	https://doaj.org/article/aa201e8af4614c48886f643668d1d52f
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Immediate results of minimally invasive redo off-pump coronary artery bypass grafting

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