China
Africa
Explore chapters and articles related to this topic
Cardiac surgery
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Minimally invasive direct coronary artery bypass (MIDCAB) grafting is performed through a strategically placed minimal access incision and so avoids all invasive aspects of conventional CABG. Through an anterior submammary incision the LIMA can be dissected down with the aid of a thoracoscope and grafted to the LAD. More lateral MIDCAB incisions allow access to other coronary vessels, including branches of the circumflex artery. Patient selection remains, at least at present, a restriction to the ever-increasing minimally invasive methods being developed. Although not yet critically evaluated, one particular approach is to combine MIDCAB (typically LIMA to LAD) with PCI to other less accessible coronary arteries (‘hybrid’ coronary revascularisation).
PCI and the cardiac surgeon: A hybrid approach
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
Michael W Cammarata, David X M Zhao
In 1995, the MIDCAB procedure was introduced into the literature. It was usually performed through anterolateral thoracotomies and could be performed without CPB (off-pump coronary artery bypass [OPCAB]).32 Although the benefits of OPCAB remain controversial and the outcomes of such procedures are more dependent on factors such as experience of the surgeon performing the procedure and33 when performed by an experienced surgeon, the outcomes can be excellent. It is the current recommendation of the ACCF/AHA that hybrid revascularisation is reasonable in patients with limitations to traditional CABG (i.e. heavily calcified aorta or poor CABG targets), lack of suitable graft conduits or an unfavourable LAD for PCI due to excessive tortuosity or chronic total occlusion. Furthermore, they state that a hybrid approach may be reasonable as an alternative to multi-vessel PCI or CABG in an attempt to improve the overall risk–benefit ratio of the procedures.31
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
Cost has been a major point of criticism since the introduction of robotics. Published data on cost are listed in Table 4. According to Cavallaro et al. who looked into differences in outcome and charges in the NIS (National Inpatient Sample) from an unmatched robotically assisted CABG was initially 15.5% cheaper than conventional CABG [28]. After propensity score matching, however, patients were charged 7.7% more for the robotic approach in single vessel revascularization and 6.0% more for multivessel revascularization. Pasrija et al. noted 32.8% more hospital costs for the totally endoscopic approach as compared to a robotically assisted MIDCAB procedure [29].
Female sex as a risk factor in minimally invasive direct coronary artery bypass grafting
Published in Scandinavian Cardiovascular Journal, 2019
Jan Gofus, Martin Vobornik, Zdenek Sorm, Martin Dergel, Mikita Karalko, Jan Harrer, Marek Pojar
MIDCAB is a safe and effective method of surgical coronary revascularization in patients with single-vessel disease. It can be routinely performed with good short- and long-term outcomes, with low overall mortality and low risk of conversion. In patients with multi-vessel disease, it can safely be used as a palliative treatment or as part of a hybrid procedure. There is no proven higher mortality in females undergoing MIDCAB, and many adverse events may be associated with other comorbidities, not female sex itself. Adequate attention should be given to wound care in women undergoing MIDCAB because of possibly higher risk of wound complications.
Successful Hybrid Minimally Invasive Revascularization and Mitral Valve Reconstruction in a High-risk Patient.
Published in Structural Heart, 2019
Mohamed El Hussein, Anthony Alozie, Alper Öner, Hueseyin Ince, Pascal Dohmen
Discussion/course of the Case: Stage I: Mitral valve clipping Stage II: MIDCAB Stage III: Additional stenting of the ramus Cx is planned. We suggest that in surgical high risk patients with severe mitral valve regurgitation and coronary artery disease, MitraClip® followed by MIDCAB and coronary stenting is a potential alternative to conventional surgery to avoid sternotomy in patients suffering from poly-morbidity including obesitas per magna to reduce sternal instability and surgical site infection. The MIDCAB-technique reduced the risk of perioperative bleeding as no complete heparinization is needed.