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Single graft LIMA to LAD surgery using cardiopulmonary bypass
Asia Pacific
Heart J 1999;8(1)
Abstracts
Of The Cardiothoracic
Section
13th Inter Annual Scientific Congress, RACS
hours (range, 1548), and the mean postoperative hospital stay was 6.1 days (range, 3-l 1). Only 3 patients (4%) had blood product transfusion. Anastomotic patency was confirmed in 25 patients by angiogram. Follow-up was 100% (mean, 8.1 months; range, l-24). None of the 50 patients in the lower stemotomy/“Octopus” group have had any re-admissions nor further procedures. Two patients out of 23 (in the thoracotomy/non-“Octopus” group) required reoperation because of recurrent angina. Conclusions: CABG surgery on the beating heart, accessed via small incisions, is feasible and can be performed safely. Exposure, mobilisation of the LIMA, and anastomotic construction via the lower stemotomy/“Octopus” method is associated with better results.
stabilisation. Methods: Seventy-three consecutive patients having minimally invasive direct coronary artery (MIDCAB) surgery without CPB were studied. Mean age was 62.2 years (range, 29-82), of whom 30 were females. The first 23 patients had a small left anterior thoracotomy, and local stabilisation techniques using epicardial stay sutures, and “foot-plates”. The last 50 patients had a lower sternotomy, and anastomotic stabilisation using the “Octopus” suction device. In each instance the LIMA was mobilised under direct vision and dilated with 1% papaverine and the LAD territory preconditioned prior to anastomosis . LAD occlusion time was shorter in the lower stemotomy/“Octopus” group (17 min vs 12 min). Results: There was no operative mortality or infarction. The postoperative intubation time was 5.1 hours (range, O-14). Average ICU stay was 27.7
Single Graft LIMA To LAD Surgery Using Cardiopulmonary Bypass C. Manganas,
H. Albrecht, R. Costa, D.C. Newman, P.W. Grant, H.D. Wolfenden Prince of Wales Hospital, Sydney, New South Wales There were 2 (1.5%) perioperative AM1 in the elective cases, and 2 (20%) in the emergency group (both PTCA related). Functional class improvement in angina occurred in 150 cases (86%). Only 13 patients had recurrent angina; 8 were restudied with all grafts patent but with new disease in other vessels (6 undergoing PTCA). Conclusions: LIMA grafting of LAD and diagonal vessels is associated with low operative mortality, excellent clinical graft patency, low incidence of recurrent angina and low re-intervention rate especially in elective cases.
Background: Before considering the role of beating heart surgery for LAD stenoses, the results from conventional techniques need to be known. Methods: The medium-term results for 185 cases of LIMA grafting to the LAD territory using CPB were reviewed retrospectively. Results: There were 141 male and 44 female patients (mean age, 59 years; range, 34-81). Forty-two were urgent and 10 were emergency cases, with 97 (52%) having previous AM1 and 16 being redo grafts. Follow-up was at 9-50 months (mean, 22). There were 2 operative and 2 late deaths, with 1 each being directly related to post-PTCA myocardial infarction.
Postoperative Angiographic Results Of Off-pump CABG Procedures M. Gardner, T. Fayers Prince Charles Hospital, Brisbane, Queensland in 1 patient who died early postoperatively. Of the 85 patent grafts, 3 exhibited a string sign (all asymptomatic), and 4 patients had stenosis at the toe of the distal anastomosis; 2 were symptomatic and underwent a repeat procedure (PTCA) . Proximal aortic anastomotic stenoses were seen in 2 patients, both had radial artery grafts and were asymptomatic. Conclusions: Angiographic results suggest that with off-pump CABG surgery, small and difficult vessels are to be avoided. Heparin is now not reserved at the end of the operation, and aspirin is continued up to the day of surgery.
Background: Sixty-three patients have undergone offpump CABG procedure utilising stabilisation from October 1997 to October 1998 (one surgeon). Methods: Planned routine postoperative angiography has been completed in 45 patients at an average of 6 hours to 137 days postoperatively (mean, 79 days). Results: Ninety distal vessels have been grafted in these 45 patients, an average of 2 grafts per patient. Conduits used were LIMA in 38, RIMA in 15, radial artery in 22, SVG in 13 and GEA in 2. Overall patency of 90 grafts has been 85 (patency rate of 94%). Four of these 5 occluded grafts are
62
Heart J 1999;8(1)
Abstracts
Of The Cardiothoracic
Section
13th Inter Annual Scientific Congress, RACS
hours (range, 1548), and the mean postoperative hospital stay was 6.1 days (range, 3-l 1). Only 3 patients (4%) had blood product transfusion. Anastomotic patency was confirmed in 25 patients by angiogram. Follow-up was 100% (mean, 8.1 months; range, l-24). None of the 50 patients in the lower stemotomy/“Octopus” group have had any re-admissions nor further procedures. Two patients out of 23 (in the thoracotomy/non-“Octopus” group) required reoperation because of recurrent angina. Conclusions: CABG surgery on the beating heart, accessed via small incisions, is feasible and can be performed safely. Exposure, mobilisation of the LIMA, and anastomotic construction via the lower stemotomy/“Octopus” method is associated with better results.
stabilisation. Methods: Seventy-three consecutive patients having minimally invasive direct coronary artery (MIDCAB) surgery without CPB were studied. Mean age was 62.2 years (range, 29-82), of whom 30 were females. The first 23 patients had a small left anterior thoracotomy, and local stabilisation techniques using epicardial stay sutures, and “foot-plates”. The last 50 patients had a lower sternotomy, and anastomotic stabilisation using the “Octopus” suction device. In each instance the LIMA was mobilised under direct vision and dilated with 1% papaverine and the LAD territory preconditioned prior to anastomosis . LAD occlusion time was shorter in the lower stemotomy/“Octopus” group (17 min vs 12 min). Results: There was no operative mortality or infarction. The postoperative intubation time was 5.1 hours (range, O-14). Average ICU stay was 27.7
Single Graft LIMA To LAD Surgery Using Cardiopulmonary Bypass C. Manganas,
H. Albrecht, R. Costa, D.C. Newman, P.W. Grant, H.D. Wolfenden Prince of Wales Hospital, Sydney, New South Wales There were 2 (1.5%) perioperative AM1 in the elective cases, and 2 (20%) in the emergency group (both PTCA related). Functional class improvement in angina occurred in 150 cases (86%). Only 13 patients had recurrent angina; 8 were restudied with all grafts patent but with new disease in other vessels (6 undergoing PTCA). Conclusions: LIMA grafting of LAD and diagonal vessels is associated with low operative mortality, excellent clinical graft patency, low incidence of recurrent angina and low re-intervention rate especially in elective cases.
Background: Before considering the role of beating heart surgery for LAD stenoses, the results from conventional techniques need to be known. Methods: The medium-term results for 185 cases of LIMA grafting to the LAD territory using CPB were reviewed retrospectively. Results: There were 141 male and 44 female patients (mean age, 59 years; range, 34-81). Forty-two were urgent and 10 were emergency cases, with 97 (52%) having previous AM1 and 16 being redo grafts. Follow-up was at 9-50 months (mean, 22). There were 2 operative and 2 late deaths, with 1 each being directly related to post-PTCA myocardial infarction.
Postoperative Angiographic Results Of Off-pump CABG Procedures M. Gardner, T. Fayers Prince Charles Hospital, Brisbane, Queensland in 1 patient who died early postoperatively. Of the 85 patent grafts, 3 exhibited a string sign (all asymptomatic), and 4 patients had stenosis at the toe of the distal anastomosis; 2 were symptomatic and underwent a repeat procedure (PTCA) . Proximal aortic anastomotic stenoses were seen in 2 patients, both had radial artery grafts and were asymptomatic. Conclusions: Angiographic results suggest that with off-pump CABG surgery, small and difficult vessels are to be avoided. Heparin is now not reserved at the end of the operation, and aspirin is continued up to the day of surgery.
Background: Sixty-three patients have undergone offpump CABG procedure utilising stabilisation from October 1997 to October 1998 (one surgeon). Methods: Planned routine postoperative angiography has been completed in 45 patients at an average of 6 hours to 137 days postoperatively (mean, 79 days). Results: Ninety distal vessels have been grafted in these 45 patients, an average of 2 grafts per patient. Conduits used were LIMA in 38, RIMA in 15, radial artery in 22, SVG in 13 and GEA in 2. Overall patency of 90 grafts has been 85 (patency rate of 94%). Four of these 5 occluded grafts are
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