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Routine Minimally Invasive Multivessel Coronary Revascularization in Obese Patients

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posted on 31.03.2021, 16:12 by Dmytro Babliak, Oleksandr Babliak, Volodymyr Demianenko, Anton Marchenko

Background
Obesity is often considered as a contraindication to minimally invasive coronary artery bypass grafting.
Our concept has been that all incoming patients for isolated surgical coronary revascularization are eligible for a coronary artery bypass grafting through the left anterior minithoracotomy. For this purpose TCRAT procedure (Total Coronary Revascularization via Left Anterior Thoracotomy) was developed.

The purpose of this study was to examine the outcomes of routine use of aforementioned surgical procedure in obese patients and determine if this approach is warranted.

Methods
We retrospectively reviewed 349 consecutive multivessel minimally invasive coronary grafting procedures done at our institution between July 2017 and January 2020, which represents the 98% of all patients who underwent isolated CABG in the same time frame.

The outcomes of those who had obesity, defined as patients with a body mass index of greater than 30 kg/m2 were compared with non-obese patients.

These groups were compared for differences in operative variables including cross clamp and cardiopulmonary bypass times as well as postoperative outcomes which included intubation times as well as ICU and hospital LOS. Postoperative complications including bleeding (return to OR) and infection (surgical wound) were also collected.

Results
Non-obese and obese groups are not significantly different with regard to numbers of a distal anastomosis (3.05±0.66 vs 2.94±0.66)

Our study results showed that patient with obesity had longer total operation time (272.9±55.6 vs 259.6±50.4 in non-obese group) and longer CPB time (145.9±37.5 vs 134.9±30.8), Regarding postoperative characteristics, obese patients also stayed longer in ICU (2.34±1.7 days against non-obese group - 2.02±0.38 days)

Total hospital mortality was 1.2% in obese group of patients.

Conclusion
Our results would suggest that minimally invasive coronary grafting with TCRAT technique could be routinely applied in obese patients with results that are not clinically different from non-obese patients.


Reference(s)

1. Babliak, O., Demianenko, V., Melnyk, Y., Revenko, K., Pidgayna, L., & Stohov, O. (2019). Complete Coronary Revascularization via Left Anterior Thoracotomy. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 14(4), 330–341. doi:10.1177/1556984519849126
2. Babliak O, Demianenko V, Melnyk Y, Revenko K, Babliak D, Stohov O, et al. Multivessel Arterial Revascularization via Left Anterior Thoracotomy. Seminars in Thoracic and Cardiovascular Surgery [Internet]. Elsevier BV; 2020 Feb; Available from: http://dx.doi.org/10.1053/j.semtcvs.2020.02.032
3. Babliak, O., Demianenko, V., Melnyk, Y., Revenko, K., Pidgayna, L., & Stohov, O. (2020).Total coronary revascularization via left anterior thoracotomy: Practical aspects. The Multimedia Manual of Cardio-Thoracic Surgery [Internet]. European Association of Cardiothoracic Surgery (EACTS Publishing Ltd); 2020 Jan 28; Available from: http://dx.doi.org/10.1510/mmcts.2019.031

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