Complete Coronary Revascularization via Left Anterior Mini Thoracotomy

Abstract

Objective: The goal of coronary bypass surgery is complete revascularization. As a current method that allows this and minimizes patient selection, we aimed to present a case series performed with the TCRAT (Total Coronary Revascularization via a small left Anterior Thoracotomy) method, together with in-hospital and 30-day results. Methods: This study included 250 patients with multivascular lesions who underwent complete coronary revascularization surgery with the TCRAT method from January 2020 to January 2024. 57 (22.8%) of the patients were female and 193 (77.2) were male. The average age was 60.8±10.1 years. All patients were operated on with standard surgical instruments. During the surgery, suspension sutures, mounted thoracic over clamp and hazelnut tampons were used to position the heart for distal anastomoses. Proximal anastomoses were performed by deviating the aorta to the left with the single clamp technique. Mean EF was 54.4±7.8%, mean BMI was 29±4.3, and mean EUROSCORE II was 2.65±1.06. All patients underwent 2 or more distal anastomoses. Results: Grafts used were LITA in 98.6.0% and SVG in 100%. On average, 3.4±0.7 anastomoses per patient were performed, with a minimum of 2 and a maximum of 5 anastomoses. The total number of distal anastomoses in the cases was 848. The Complete anatomical revascularization was achieved in 100 %. The average intensive care unit follow-up time was 38.1±6.2 hours, and the average ward follow-up time was 100.7±10.3 hours. No postoperative cardiac tamponade was observed in any patient during this period. Only 2 patients (0.8%) required revision due to bleeding. Hospital mortality was 0.4%, and 30-day mortality was 2.4%. Conclusion: The TCRAT technique is the most up-to-date method that enables complete revascularization and avoids sternotomy in coronary surgery, and it is also valuable that it can be performed with standard surgical instruments. Long-term results will clarify the value of this technique. Keywords: Minimaly invasive cardiac surgery, coronary artery bypass grafting, Minimally invasive direct coronary artery bypass, Revascularisation, Left anterior thoracotomy

Keywords

• Minimaly invasive cardiac surgery
• coronary artery bypass grafting
• Minimally invasive direct coronary artery bypass
• Revascularisation
• Left anterior thoracotomy

Sol Anterior Mini Torakotomi ile Tam Koroner Revaskülarizasyon

Öz

Amaç: Koroner bypass cerrahisinin amacı tam revaskülarizasyondur. Bunu sağlayan ve hasta seçimini en aza indiren güncel bir yöntem olarak TCRAT ( Küçük Sol Anterior Torakotomi ile Total Koroner Revaskülarizasyon) yöntemi ile yapılan bir olgu serisini hastane içi ve 30 günlük sonuçlarıyla birlikte sunmayı amaçladık. Yöntemler: Bu çalışmaya Ocak 2020'den Ocak 2024'e kadar TCRAT yöntemi ile tam koroner revaskülarizasyon ameliyatı geçiren multivasküler lezyonlu 250 hasta dahil edildi. Hastaların 57'si (%22,8) kadın, 193'ü (77,2) erkekti. Ortalama yaş 60,8±10,1 yıl idi. Tüm hastalar standart cerrahi aletler kullanılarak ameliyat edildi. Ameliyat sırasında, distal anastomozlar için kalbi konumlandırmak amacıyla askı dikişleri, torasik klemp ve fındık tamponları kullanıldı. Proksimal anastomozlar, aortu sola doğru iterek tek klemp tekniği ile yapıldı. Ortalama EF %54,4±7,8, ortalama VKİ 29±4,3 ve ortalama EUROSCORE II 2,65±1,06 idi. Tüm hastalara 2 veya daha fazla distal anastomoz yapıldı. Bulgular: Kullanılan greftler %98,6.0 LITA ve %100 SVG idi. Ortalama olarak hasta başına 3,4±0,7 anastomoz yapıldı, en az 2, en çok 5 anastomoz yapıldı. Olgulardaki toplam distal anastomoz sayısı 848 idi. Tam anatomik revaskülarizasyon %100 oranında başarıldı. Ortalama yoğun bakım izlem süresi 38,1±6,2 saat, ortalama servis izlem süresi 100,7±10,3 saat idi. Bu dönemde hiçbir hastada postoperatif kardiyak tamponad görülmedi. Sadece 2 hasta (%0,8) kanama nedeniyle revizyona ihtiyaç duydu. Hastane mortalitesi %0,4, 30 günlük mortalite ise %2,4 idi. Sonuç: TCRAT tekniği koroner cerrahide tam revaskülarizasyon sağlayan ve sternotomi gerektirmeyen en güncel yöntemdir ve standart cerrahi aletler ile uygulanabilmesi de değerlidir. Uzun dönem sonuçları bu tekniğin değerini daha da netleştirecektir.

Anahtar Kelimeler

• Minimal invazif kalp cerrahisi
• koroner arter baypas greft
• minimal invazif direkt koroner arter baypas
• sol anterior torakotomi
• revaskülarizasyon

References

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