BACKGROUND: This retrospective study was undertaken to determine the long-term angiographic patency and clinical outcomes of the endoscopic atraumatic coronary artery bypass (endoACAB) procedure. METHODS: Between November 1997 and March 2005, 607 consecutive patients underwent an endoACAB consisting of (1) unilateral or bilateral manual, thoracoscopic internal mammary artery (IMA) harvesting, (2) creation of a needle-directed access port in the thoracic soft tissue (non-rib-spreading), (3) cardiac positioning and stabilization using port-based instrumentation, and (4) off-pump, direct-vision, hand-sewn anastomoses to the left anterior descending (LAD), diagonal, obtuse marginal, or main right coronary arteries, or a combination. Mean follow-up time was 18.0 +/- 16.0 months (range, 2.0 to 85.7 months). RESULTS: The IMA was used to graft the LAD in all cases. A total of 721 anastomoses were constructed using 636 conduits. Thirty-day mortality was 1.0% (6/607). A total of 379 (62.4%) had coronary angiography after operation at a mean of 18.4 +/- 17.0 months. The overall patency for the LIMA to LAD was FitzGibbon A, 95.2% (324/340), and FitzGibbon A and B, 98.5% (335/340). At 5 years, event-free survival was 92% +/- 2.4%. CONCLUSIONS: The clinical outcome and angiographic patency of grafting the LAD with the LIMA off pump through a non-rib-spreading incision compares favorably with the reported data of arrested heart grafting through a median sternotomy. The endoACAB offers an excellent alternative for patients with LAD disease as a stand-alone procedure, a multivessel grafting procedure in selected patients, or as part of a hybrid procedure in conjunction with a percutaneous intervention.
BACKGROUND: This retrospective study was undertaken to determine the long-term angiographic patency and clinical outcomes of the endoscopic atraumatic coronary artery bypass (endoACAB) procedure. METHODS: Between November 1997 and March 2005, 607 consecutive patients underwent an endoACAB consisting of (1) unilateral or bilateral manual, thoracoscopic internal mammary artery (IMA) harvesting, (2) creation of a needle-directed access port in the thoracic soft tissue (non-rib-spreading), (3) cardiac positioning and stabilization using port-based instrumentation, and (4) off-pump, direct-vision, hand-sewn anastomoses to the left anterior descending (LAD), diagonal, obtuse marginal, or main right coronary arteries, or a combination. Mean follow-up time was 18.0 +/- 16.0 months (range, 2.0 to 85.7 months). RESULTS: The IMA was used to graft the LAD in all cases. A total of 721 anastomoses were constructed using 636 conduits. Thirty-day mortality was 1.0% (6/607). A total of 379 (62.4%) had coronary angiography after operation at a mean of 18.4 +/- 17.0 months. The overall patency for the LIMA to LAD was FitzGibbon A, 95.2% (324/340), and FitzGibbon A and B, 98.5% (335/340). At 5 years, event-free survival was 92% +/- 2.4%. CONCLUSIONS: The clinical outcome and angiographic patency of grafting the LAD with the LIMA off pump through a non-rib-spreading incision compares favorably with the reported data of arrested heart grafting through a median sternotomy. The endoACAB offers an excellent alternative for patients with LAD disease as a stand-alone procedure, a multivessel grafting procedure in selected patients, or as part of a hybrid procedure in conjunction with a percutaneous intervention.
Authors: Ralf E Harskamp; Zhe Zheng; John H Alexander; Judson B Williams; Ying Xian; Michael E Halkos; J Matthew Brennan; Robbert J de Winter; Peter K Smith; Renato D Lopes Journal: Ann Thorac Surg Date: 2013-12 Impact factor: 4.330
Authors: Robert S Poston; Richard Tran; Michael Collins; Marty Reynolds; Ingrid Connerney; Barry Reicher; David Zimrin; Bartley P Griffith; Stephen T Bartlett Journal: Ann Surg Date: 2008-10 Impact factor: 12.969