China
Africa
Explore chapters and articles related to this topic
The Coronaries
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Claudio Muneretto, Chang Guohao, Theo Kofidis
Hybrid coronary revascularization is the planned use of minimally invasive LIMA-LAD revascularization and PCI. There are various approaches a surgeon can adopt by using this concept; ranging from the simplest MIDCAB and PCI to non-LAD lesions to the complex robotic-assisted revascularization of the left-sided coronary stenoses via the left anterior thoracotomy followed by PCI to the right-sided coronary stenoses. The sequence at which this is carried out has its pros and cons, which will be further elaborated on in the section below on “caveats and controversies”.
Surgical management of coronary artery disease
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Melissa M. Anastacio, Alejandro Suarez Pierre, Jennifer S. Lawton
Surgical alternatives to standard median sternotomy and on-pump CABG have emerged in an attempt to minimize the potentially deleterious effects of CPB and aortic manipulation. Options include minimally invasive direct coronary artery bypass, robotic-assisted CABG, and hybrid coronary revascularization. These operations have been demonstrated to have low postoperative morbidity and mortality and acceptable short- and long-term outcomes in experienced centers (72,74). Although patients over the age of 65 were included in these studies, the majority of the patients were younger with normal left ventricular function. Additionally, these surgical options are limited by the severity of CAD and complexity of coronary anatomy. Benefit beyond traditional CABG techniques (sternotomy) has yet to be determined in elderly patients.
Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
CABG is a major surgical operation where atheromatous blockages in a patient's coronary arteries are bypassed with harvested venous or arterial conduits. The bypass restores blood flow to the ischaemic myocardium which, in turn, restores function viability and relieves anginal symptoms. Almost 400,000 CABG surgeries are performed each year making it the most commonly performed major surgical procedure, but surgical trends have decreased as the use of alternative options such as medical treatment and PCI have increased. Coronary stenting has an increasing role in multi-vessel and left main CAD and, as a result, bypass surgery has decreased. CABG remains the ‘gold standard’ treatment for multi-vessel CAD, particularly for three-vessel or left main CAD. The conduits used as bypass grafts are routinely the LIMA and the saphenous vein grafts (SVG) out of the lower extremities. Other conduits include the right internal mammary artery (RIMA), the radial artery, and the gastroepiploic artery. The type and location of the grafts depend on the patient's anatomy and the location of the arteries that are occluded. Typically, the LIMA is grafted to the left anterior descending (LAD) artery, and the other conduits are used for the other occluded arteries. Several trials comparing CABG and PCI have reported similar complications but CABG patients undergo fewer revascularization procedures. This superiority is likely attributable to the long-term patency of the LIMA to the LAD anastomosis, as the majority of the left ventricular blood supply comes from the left main coronary artery. This rationale has led to the development of hybrid coronary revascularization, in which the LIMA-LAD bypass graft is completed through a minimally invasive technique, while PCI is performed on non-LAD arteries.
Robotic totally endoscopic coronary artery bypass grafting: current status and future prospects
Published in Expert Review of Medical Devices, 2020
Johannes Bonatti, Stephanie Wallner, Bernhard Winkler, Martin Grabenwöger
Robotic totally endoscopic coronary artery bypass grafting, the so-called TECAB procedure, has been under development for more than 20 years. Within this time frame, it has matured from placement of single bypass grafts to completely endoscopic construction of multiple grafts and can be carried out on the beating heart and with cardioplegia. Combinations with percutaneous coronary interventions called hybrid coronary revascularization are frequently performed. Cardiac surgeons have used three generations of robotic devices and every generation has brought important technological developments. The most important ones were the endowrist technology which due to the seven degrees of freedom allows completely endoscopic suturing of a coronary anastomosis, the introduction of a robotic, endoscopic suction stabilizer for performance of TECAB on the beating heart, and the introduction of an anastomotic connector. The latter is so far not available as a robotic instrument but there would be a good potential for integration into the technology similar to the way staplers for lung resection were made robotic instruments.