Thoracoscopic Transmyocardial Laser Revascularization: Is Prior Coronary Artery Bypass Grafting a Contraindication?

Author:

Allen Gary S.1,Budde Jason1

Affiliation:

1. Osceola Regional Medical Center, Orlando, Florida.

Abstract

Objective Recently, thoracoscopic techniques have been used to perform transmyocardial laser revascularization (TMR) in patients who are not suitable candidates for coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions. Whether or not prior CABG contraindicates a port access–only approach to TMR is unclear. This study compares patients with and without prior CABG who have undergone thoracoscopic TMR. Methods Between May 2003 and October 2005, 23 consecutive patients (6 without prior CABG, group A; and 17 with prior CABG, group B) underwent thoracoscopic TMR, using a holmium:yttriumaluminum-garnet (Ho:YAG) laser system. Either 3 or 4 port incisions (each ≤2 cm in length) were used, depending on the patient's anatomy. Procedural success was defined as the ability to create all intended channels without conversion to thoracotomy. Results Patient demographics were not significantly different between group A and group B (mean age, 65.8 ± 4.3 years versus 67.4 ± 2.4 years, Canadian Cardiovascular Society angina class 3.7 ± 0.2 versus 3.9 ± 0.1, and Parsonnet score 12.0 ± 3.2 versus 20.5 ± 2.4). Fourteen (82.4%) group B patients had a prior left internal mammary artery to left anterior descending artery graft, of which 12 (85.7%) were patent. One patient in group A had an airway injury at intubation that led to an extended hospital stay of 30 days. One patient in group A (16.7%) and one patient in group B (5.9%) required a blood transfusion (P = NS). Adhesion lysis time in group B ranged from 0 to 68 minutes (mean, 27 ± 5.6 minutes). Neither group had a conversion to thoracotomy or any deaths through a mean combined follow-up of 12 months. Conclusions A port access approach is safe and reproducible for patients who are candidates for sole therapy TMR. Prior CABG, including patent grafts, is not a contraindication to thoracoscopic TMR.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,General Medicine,Surgery,Pulmonary and Respiratory Medicine

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Video-assisted thoracoscopic surgery approach for transmyocardial laser revascularization;Interactive CardioVascular and Thoracic Surgery;2017-05-26

2. Intraoperative Temperature Management;Therapeutic Hypothermia and Temperature Management;2013-06

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