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Thorac Cardiovasc Surg 2019; 67(06): 437-443
DOI: 10.1055/s-0038-1670632
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Coronary Artery Bypass Grafting using Bilateral Internal Thoracic Arteries through a Left-Sided Minithoracotomy: A Single-Center Starting Experience

Mahmoud Diab
1   Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
,
Gloria Färber
1   Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
,
Christoph Sponholz
2   Department Anesthesiology and Critical Care Medicine, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
,
Raphael Tasar
1   Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
,
Thomas Lehmann
3   Center for Clinical Studies, University Hospital, Friedrich-Schiller-University Jena, Germany
,
Sophie Tkebuchava
1   Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
,
Marcus Franz
4   Department of Internal Medicine I/Cardiology, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
,
Torsten Doenst
1   Department of Cardiothoracic Surgery, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
› Author Affiliations
Further Information

Publication History

18 May 2018

24 July 2018

Publication Date:
07 September 2018 (online)

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Abstract

Background Coronary artery bypass grafting (CABG) using bilateral internal thoracic artery (BITA) is associated with the best long-term survival. However, using BITA increases the risk of sternal wound infections with conventional sternotomy. We describe here our initial results of minimally invasive CABG (MICS-CABG) using BITA.

Methods Patients were operated through an incision similar to that of standard minimally invasive direct CABG. All operations were performed off-pump. We evaluated patient's quality of life (QoL) using the Medical Outcomes trust, 36-Item Short Form Health Survey (SF-36).

Results Between February 2016 and August 2017, we performed 21 cases of MICS-CABG using BITA. There was no intraoperative complication and no conversion to sternotomy or to on-pump. Two patients required reexploration through the same minithoracotomy for postoperative bleeding. Two cases of early postoperative graft failure were identified. There was no stroke or in-hospital mortality. The median duration of follow-up was 13 months, with a maximum of 19 months. Relief of angina was achieved in all patients. There was one readmission for superficial wound infection, which was conservatively treated. An 84-year-old man died 4 months after the operation. The remaining 20 patients attested good QoL with the SF-36 questionnaire.

Conclusions Myocardial revascularization using BITA can be safely achieved off-pump through a left-sided minithoracotomy with good postoperative and short-term outcomes.

Keywords

coronary artery bypass grafting - bilateral internal thoracic arteries - minimally invasive - mortality

Ethical Approval

The study was approved by the local ethics committee (Nr. 5410–01/18).


Informed Consent

Due to the retrospective nature of this study, there was no specific informed consent. However, patients undergoing surgery in our department sign a general informed consent agreeing on the use of their data in an anonymous form for future database analyses.


Supplementary Material

 

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