Surgery Journal| Lupine Publishers
MINI OPCAB surgery (Xiphoid Approach) is a surgical technique in
which the left internal mammary artery is bypassed to the
Anterior Descending Artery (ADA) by a medial inferior sternotomy
Fourteen high risk patients with multiple coronary disease with
a preoperative logistic Euroscore of 10.86 were operated and follow up
with medical treatment and strictly control of risks factors
MACE at 80 months was 0% and Survival at 7 years 82% (KM) Although is an
alternative the combination of Mini OPCAB operation
plus medical treatment in high risk. Patients with multiple vessels
coronary disease, more experience is needed to confirm this
initials results. Statistical analysis applied the student test (SPSS
program), with p<0.05 were considered significant
Keywords: Mini Opcab; Minimally Invasive Coronary Surgery; Coronary High Risk Patients
In high-risk patients with multiple vessel disease who are
not candidates for conventional surgery with extracorporeal
circulation or for percutaneous procedures as a single treatment,
the alternative of left mammary artery to left internal descending
artery bypass graft surgery without extracorporeal circulation
offers advantages over medical treatment [1,2].
Figure 1:
Figure 2:
a) The MIDCAB operation
b) Is effective to treat high risk patients with multiple vessel
disease. Greater long-term follow-up is necessary to clarify the
indications and validate the procedure for this type of patients.
c) MINI OPCAB surgery (Xiphoid Approach) is a surgical
technique in which the left internal mammary artery is
bypassed to the Anterior Descending Artery (ADA) by a medial
inferior sternotomy approach in the 3rd or 4th intercostal space,
leaving intact the sternal manubrium (Figures 1 & 2). Long-term
results have already been published, reaching 82% survival at
12 years (Kaplan-Meier).
d) This presentation describes the experience with this
surgical technique in our institution [3,4].
Fourteen high risk patients with multiple vessel coronary
artery disease with mean age of 71.07 years (±9.051, 95% CI),
21% women and mean preoperative Logistic EuroSCORE of 10.68
(±5.407, 95% CI), were operated-on in the last 7 years, followed up
in our institution with strict medical treatment and control of risk
factors.
Operative mortality in this series was 0%, the incidence of
perioperative infarction was 0%, the average duration of surgery
was 2 hours and 20 minutes; 10 (71%) patients were extubated
in the operating room and average hospital stay was 2 days and
11 hours. Following the intervention, one patient received a stent
in the right coronary artery and another in the circumflex artery
for presenting large arteries with severe lesions. In this group
of patients, major adverse cardiovascular events were 0% at
80 months. Survival rate was 82% at 7 years (Kaplan-Meier); an
85-year-old woman died 5 years after surgery due to stroke.
The combination of a MINI-OPCAB surgery for bypass of the
left internal mammary artery to the left anterior descending artery
[5,6] together with an adequate medical treatment and a hybrid
treatment when the right coronary artery or circumflex artery are
of high caliber, is a viable option for elderly and high-risk patients.
More experience is needed to confirm these initial results.
MINI OPCAB surgery (Xiphoid Approach) is a surgical technique in
which the left internal mammary artery is bypassed to the
Anterior Descending Artery (ADA) by a medial inferior sternotomy
Fourteen high risk patients with multiple coronary disease with
a preoperative logistic Euroscore of 10.86 were operated and follow up
with medical treatment and strictly control of risks factors
MACE at 80 months was 0% and Survival at 7 years 82% (KM) Although is an
alternative the combination of Mini OPCAB operation
plus medical treatment in high risk. Patients with multiple vessels
coronary disease, more experience is needed to confirm this
initials results. Statistical analysis applied the student test (SPSS
program), with p<0.05 were considered significant
Keywords: Mini Opcab; Minimally Invasive Coronary Surgery; Coronary High Risk Patients
In high-risk patients with multiple vessel disease who are
not candidates for conventional surgery with extracorporeal
circulation or for percutaneous procedures as a single treatment,
the alternative of left mammary artery to left internal descending
artery bypass graft surgery without extracorporeal circulation
offers advantages over medical treatment [1,2].
Figure 1:
Figure 2:
a) The MIDCAB operation
b) Is effective to treat high risk patients with multiple vessel
disease. Greater long-term follow-up is necessary to clarify the
indications and validate the procedure for this type of patients.
c) MINI OPCAB surgery (Xiphoid Approach) is a surgical
technique in which the left internal mammary artery is
bypassed to the Anterior Descending Artery (ADA) by a medial
inferior sternotomy approach in the 3rd or 4th intercostal space,
leaving intact the sternal manubrium (Figures 1 & 2). Long-term
results have already been published, reaching 82% survival at
12 years (Kaplan-Meier).
d) This presentation describes the experience with this
surgical technique in our institution [3,4].
Fourteen high risk patients with multiple vessel coronary
artery disease with mean age of 71.07 years (±9.051, 95% CI),
21% women and mean preoperative Logistic EuroSCORE of 10.68
(±5.407, 95% CI), were operated-on in the last 7 years, followed up
in our institution with strict medical treatment and control of risk
factors.
Operative mortality in this series was 0%, the incidence of
perioperative infarction was 0%, the average duration of surgery
was 2 hours and 20 minutes; 10 (71%) patients were extubated
in the operating room and average hospital stay was 2 days and
11 hours. Following the intervention, one patient received a stent
in the right coronary artery and another in the circumflex artery
for presenting large arteries with severe lesions. In this group
of patients, major adverse cardiovascular events were 0% at
80 months. Survival rate was 82% at 7 years (Kaplan-Meier); an
85-year-old woman died 5 years after surgery due to stroke.
The combination of a MINI-OPCAB surgery for bypass of the
left internal mammary artery to the left anterior descending artery
[5,6] together with an adequate medical treatment and a hybrid
treatment when the right coronary artery or circumflex artery are
of high caliber, is a viable option for elderly and high-risk patients.
More experience is needed to confirm these initial results.
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