Minimally Invasive Coronary Arter Bypass Grafting
Özet
This chapter examines the techniques, history, and clinical applications of minimally invasive coronary artery bypass grafting (MICS-CABG). MICS-CABG involves performing coronary bypass surgery through smaller incisions while minimizing or avoiding the use of cardiopulmonary bypass (CPB). This approach is commonly used for bypassing the left anterior descending artery (LAD) through minimal access.
The foundations of coronary surgery were established in the 1960s, with Kolessov performing the first LAD grafting without CPB. Since then, thoracoscopic and robotic-assisted techniques have significantly advanced the field. MICS-CABG offers benefits such as smaller incisions, reduced postoperative pain, quicker recovery, and shorter hospital stays.
Patient selection plays a critical role in the success of MICS-CABG. Hemodynamically stable patients are the most suitable candidates. Contraindications include severe pulmonary disease, pectus excavatum deformity, and complex coronary anatomies. MICS-CABG is particularly effective for single-vessel disease requiring revascularization of the LAD and has become an increasingly popular alternative to traditional coronary bypass surgery due to its minimally invasive nature.
Bu bölümde minimal invaziv koroner arter bypass greftleme (MICS-CABG) teknikleri, tarihçesi ve klinik uygulamaları ele alınmaktadır. MICS-CABG, klasik kardiyopulmoner baypas (CPB) kullanımını minimize eden veya tamamen ortadan kaldıran yöntemler kullanılarak gerçekleştirilir. Bu teknik, özellikle sol anterior inen arter (LAD) için minimal insizyonlarla gerçekleştirilen bypass cerrahisini ifade eder.
Koroner cerrahinin temelleri 1960’larda atılmış ve zamanla minimal invaziv yaklaşımlar geliştirilmiştir. Kolessov’un LAD greftlemesiyle başlayan süreçte, thorakoskopik ve robot destekli teknikler önemli gelişmeler sağlamıştır. MICS-CABG, hastalara daha küçük insizyonlar, daha az postoperatif ağrı, daha hızlı iyileşme süresi ve daha kısa hastanede kalış süresi gibi avantajlar sunar.
Hasta seçimi bu teknikte büyük önem taşır. Hemodinamik olarak stabil hastalar, minimal invaziv yaklaşımlar için daha uygun kabul edilir. Kontrendikasyonlar arasında ciddi pulmoner hastalıklar, pektus ekskavatum deformitesi ve kompleks koroner anatomiler yer alır. MICS-CABG, özellikle tek damar hastalığı olan ve LAD’ye yönelik revascularizasyon gereken vakalarda etkili bir tedavi seçeneğidir.
Referanslar
Aris A. Francisco Romero, the first heart surgeon. Ann Thorac Surg. 1997;64(3):870-871. doi:10.1016/s0003-4975(97)00760-1
Braile DM, Godoy MF de. History of heart surgery in the world. 1996. Rev Bras Cir Cardiovasc Orgao Of Soc Bras Cir Cardiovasc. 2012;27(1):125-136. doi:10.5935/1678-9741.20120019
Blatchford JW. Ludwig Rehn: the first successful cardiorrhaphy. Ann Thorac Surg. 1985;39(5):492-495. doi:10.1016/s0003-4975(10)61972-8
Johnson PSL. The History of Cardiac Surgery, 1896-1955. The Johns Hopkins University Press; 1970.
Gıbbon JH Jr. Artificial maintenance of circulation during experimental occlusion of pulmonary artery. Arch Surg. 1937;34(6):1105-1131. doi:10.1001/archsurg.1937.01190120131008
Vineberg A. Coronary vascular anastomoses by internal mammary arter implantation. Can Med Assoc J. 1958;78(11):871-879.
Meyer JA. Werner Forssmann and catheterization of the heart, 1929. Ann Thorac Surg. 1990;49(3):497-499. doi:10.1016/0003-4975(90)90272-8
Kolessov VI. Mammary artery-coronary artery anastomosis as method of treatment for angina pectoris. J Thorac Cardiovasc Surg. 1967;54(4):535-544.
Ankeny JL. Editorial: To use or not to use the pump oxygenator in coronary bypass operations. Ann Thorac Surg. 1975;19(1):108-109. doi:10.1016/s0003-4975(10)65744-x
Favaloro RG. Saphenous vein autograft replacement of severe segmental coronary artery occlusion: operative technique. Ann Thorac Surg. 1968;5(4):334-339. doi:10.1016/s0003-4975(10)66351-5
Garrett HE, Dennis EW, DeBakey ME. Aortocoronary bypass with saphenous vein graft. Seven-year follow-up. JAMA. 1973;223(7):792-794.
Trapp WG, Bisarya R. Placement of coronary artery bypass graft without pump oxygenator. Ann Thorac Surg. 1975;19(1):1-9. doi:10.1016/s0003-4975(10)65725-6
Calafiore AM, Angelini GD, Bergsland J, Salerno TA. Minimally invasive coronary artery bypass grafting. Ann Thorac Surg. 1996;62(5):1545-1548. doi:10.1016/0003-4975(96)00794-1
Benetti FJ, Ballester C, Sani G, Doonstra P, Grandjean J. Video Assisted Coronary Bypass Surgery. J Card Surg. 1995;10(6):620-625. doi:10.1111/j.1540-8191.1995.tb00651.x
Benetti FJ, Ballester C. Use of thoracoscopy and a minimal thoracotomy, in mammary-coronary bypass to left anterior descending artery, without extracorporeal circulation. Experience in 2 cases. J Cardiovasc Surg (Torino). 1995;36(2):159-161.
McGinn JT, Usman S, Lapierre H, Pothula VR, Mesana TG, Ruel M. Minimally Invasive Coronary Artery Bypass Grafting. Circulation. 2009;120(11_suppl_1):S78-S84. doi:10.1161/CIRCULATIONAHA.108.840041
Lamelas J, Williams RF, Mawad M, LaPietra A. Complications Associated With Femoral Cannulation During Minimally Invasive Cardiac Surgery. Ann Thorac Surg. 2017;103(6):1927-1932. doi:10.1016/j.athoracsur.2016.09.098
Chan EY, Lumbao DM, Iribarne A, et al. Evolution of Cannulation Techniques for Minimally Invasive Cardiac Surgery a 10-Year Journey. Innovations. 2012;7(1):9-14. doi:10.1097/imi.0b013e318253369a
Colangelo N, Torracca L, Lapenna E, Moriggia S, Crescenzi G, Alfieri O. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Perfusion. 2006;21(6):361-365. doi:10.1177/0267659106071324
Xu C, Pan J, Zhou Q, et al. Right vertical infra-axillary thoracotomy for double valve replacement. J Card Surg. 2015;30(5):427-430. doi:10.1111/jocs.12516
Lamelas J. Minimally invasive concomitant aortic and mitral valve surgery: the “Miami Method.” Ann Cardiothorac Surg. 2015;4(1):33-37. doi:10.3978/j.issn.2225-319X.2014.08.17
Marin-Cuartas M, Sá MP, Torregrossa G, Davierwala PM. Minimally invasive coronary artery surgery: Robotic and nonrobotic minimally invasive direct coronary artery bypass techniques. JTCVS Tech. 2021;10:170-177. doi:10.1016/j.xjtc.2021.10.008
Murry CE, Richard VJ, Reimer KA, Jennings RB. Ischemic preconditioning slows energy metabolism and delays ultrastructural damage during a sustained ischemic episode. Circ Res. 1990;66(4):913-931. doi:10.1161/01.res.66.4.913
Calafiore AM, Di Giammarco G, Teodori G, et al. Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass. Ann Thorac Surg. 1996;61(6):1658-1665. doi:10.1016/0003-4975(96)00187-7
Monsefi N, Alaj E, Sirat S, Bakhtiary F. Postoperative results of minimally invasive direct coronary artery bypass procedure in 234 patients. Front Cardiovasc Med. 2022;9:1051105. doi:10.3389/fcvm.2022.1051105
Bonatti J, Wallner S, Crailsheim I, Grabenwöger M, Winkler B. Minimally invasive and robotic coronary artery bypass grafting-a 25-year review. J Thorac Dis. 2021;13(3):1922-1944. doi:10.21037/jtd-20-1535
Al-Ruzzeh S, Mazrani W, Wray J, et al. The clinical outcome and quality of life following minimally invasive direct coronary artery bypass surgery. J Card Surg. 2004;19(1):12-16. doi:10.1111/j.0886-0440.2004.04003.x
