Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomyCentral MessagePerspective
Objective: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy demonstrated promising early outcomes in unselected patients with coronary artery multivessel disease. Follow-up data are still missing. Methods: From November 2019 to September...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-08-01
|
| Series: | JTCVS Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724002396 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849405279594086400 |
|---|---|
| author | Christian Sellin, MD Ahmed Belmenai, MD Margit Niethammer, MD Volker Schächinger, MD, PhD Hilmar Dörge, MD, PhD |
| author_facet | Christian Sellin, MD Ahmed Belmenai, MD Margit Niethammer, MD Volker Schächinger, MD, PhD Hilmar Dörge, MD, PhD |
| author_sort | Christian Sellin, MD |
| collection | DOAJ |
| description | Objective: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy demonstrated promising early outcomes in unselected patients with coronary artery multivessel disease. Follow-up data are still missing. Methods: From November 2019 to September 2023, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed as a routine procedure in 392 consecutive, nonemergency patients (345 men; 67.0 ± 9.9 years; range, 32-88 years). All patients had multivessel coronary artery disease (77.6% 3-vessel-disease, 22.4% 2-vessel-disease, and 32.9% left main stenosis). Patients at old age (older than a 80 years, 12.5%), with severe left ventricular dysfunction (ejection fraction <30%, 7.9%), diabetes mellitus (34.9%), massive obesity (body mass index > 35, 8.9%), and chronic lung disease (17.1%) were included. Mean European System for Cardiac Operative Risk Evaluation II score was 2.9 ± 2.8. Mean midterm follow-up (100%) was 15.2 ± 10.7 months (range, 0.1-39.5 months). Results: Left internal thoracic artery (99.0%), radial artery (70.4%), and saphenous vein grafts (57.4%) were used, and 70.4% of patients received at least 2 arterial grafts. A total of 3.0 ± 0.8 anastomoses (range, 2-5 anastomoses) per patient were performed to revascularize the territories of left anterior descending (98.7%), circumflex (91.6%), and right coronary (70.9%) artery. Complete anatomical revascularization was achieved in 95.1%. At follow-up, all-cause-mortality, myocardial infarction, repeat revascularization, and stroke was 3.1%, 1.5%, 5.4%, and 0.7%, respectively. Overall major adverse cardiac and cerebrovascular events rate was 8.7%. Conclusions: This is the first report of midterm follow-up after routine sternum-sparing total coronary revascularization via left anterior thoracotomy for multivessel coronary artery disease with a high rate of multiple arterial grafting and complete anatomical revascularization. Outcome was favorable and similar to that of contemporary conventional coronary artery bypass grafting. |
| format | Article |
| id | doaj-art-c43d05422fc74756b9362e5bf027512e |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-c43d05422fc74756b9362e5bf027512e2025-08-20T03:36:42ZengElsevierJTCVS Techniques2666-25072024-08-0126526010.1016/j.xjtc.2024.05.018Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomyCentral MessagePerspectiveChristian Sellin, MD0Ahmed Belmenai, MD1Margit Niethammer, MD2Volker Schächinger, MD, PhD3Hilmar Dörge, MD, PhD4Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, Germany; Address for reprints: Christian Sellin, MD, Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Pacelliallee 4, Fulda, 36043, Germany.Department of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, GermanyDepartment of Cardiology, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, GermanyDepartment of Cardiology, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, GermanyDepartment of Cardiothoracic Surgery, Heart-Thorax Center, Klinikum Fulda, University Medicine Marburg, Campus Fulda, Fulda, GermanyObjective: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy demonstrated promising early outcomes in unselected patients with coronary artery multivessel disease. Follow-up data are still missing. Methods: From November 2019 to September 2023, coronary artery bypass grafting via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic cardiac arrest was performed as a routine procedure in 392 consecutive, nonemergency patients (345 men; 67.0 ± 9.9 years; range, 32-88 years). All patients had multivessel coronary artery disease (77.6% 3-vessel-disease, 22.4% 2-vessel-disease, and 32.9% left main stenosis). Patients at old age (older than a 80 years, 12.5%), with severe left ventricular dysfunction (ejection fraction <30%, 7.9%), diabetes mellitus (34.9%), massive obesity (body mass index > 35, 8.9%), and chronic lung disease (17.1%) were included. Mean European System for Cardiac Operative Risk Evaluation II score was 2.9 ± 2.8. Mean midterm follow-up (100%) was 15.2 ± 10.7 months (range, 0.1-39.5 months). Results: Left internal thoracic artery (99.0%), radial artery (70.4%), and saphenous vein grafts (57.4%) were used, and 70.4% of patients received at least 2 arterial grafts. A total of 3.0 ± 0.8 anastomoses (range, 2-5 anastomoses) per patient were performed to revascularize the territories of left anterior descending (98.7%), circumflex (91.6%), and right coronary (70.9%) artery. Complete anatomical revascularization was achieved in 95.1%. At follow-up, all-cause-mortality, myocardial infarction, repeat revascularization, and stroke was 3.1%, 1.5%, 5.4%, and 0.7%, respectively. Overall major adverse cardiac and cerebrovascular events rate was 8.7%. Conclusions: This is the first report of midterm follow-up after routine sternum-sparing total coronary revascularization via left anterior thoracotomy for multivessel coronary artery disease with a high rate of multiple arterial grafting and complete anatomical revascularization. Outcome was favorable and similar to that of contemporary conventional coronary artery bypass grafting.http://www.sciencedirect.com/science/article/pii/S2666250724002396minimally invasive cardiac surgerycoronary artery bypass graftingCABGTCRAT |
| spellingShingle | Christian Sellin, MD Ahmed Belmenai, MD Margit Niethammer, MD Volker Schächinger, MD, PhD Hilmar Dörge, MD, PhD Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomyCentral MessagePerspective JTCVS Techniques minimally invasive cardiac surgery coronary artery bypass grafting CABG TCRAT |
| title | Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomyCentral MessagePerspective |
| title_full | Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomyCentral MessagePerspective |
| title_fullStr | Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomyCentral MessagePerspective |
| title_full_unstemmed | Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomyCentral MessagePerspective |
| title_short | Sternum-sparing multivessel coronary surgery as a routine procedure: Midterm results of total coronary revascularization via left anterior thoracotomyCentral MessagePerspective |
| title_sort | sternum sparing multivessel coronary surgery as a routine procedure midterm results of total coronary revascularization via left anterior thoracotomycentral messageperspective |
| topic | minimally invasive cardiac surgery coronary artery bypass grafting CABG TCRAT |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724002396 |
| work_keys_str_mv | AT christiansellinmd sternumsparingmultivesselcoronarysurgeryasaroutineproceduremidtermresultsoftotalcoronaryrevascularizationvialeftanteriorthoracotomycentralmessageperspective AT ahmedbelmenaimd sternumsparingmultivesselcoronarysurgeryasaroutineproceduremidtermresultsoftotalcoronaryrevascularizationvialeftanteriorthoracotomycentralmessageperspective AT margitniethammermd sternumsparingmultivesselcoronarysurgeryasaroutineproceduremidtermresultsoftotalcoronaryrevascularizationvialeftanteriorthoracotomycentralmessageperspective AT volkerschachingermdphd sternumsparingmultivesselcoronarysurgeryasaroutineproceduremidtermresultsoftotalcoronaryrevascularizationvialeftanteriorthoracotomycentralmessageperspective AT hilmardorgemdphd sternumsparingmultivesselcoronarysurgeryasaroutineproceduremidtermresultsoftotalcoronaryrevascularizationvialeftanteriorthoracotomycentralmessageperspective |