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Anomalous Aortic Origin of a Coronary Artery Repair Through an Anterior Minithoracotomy.

Publication ,  Journal Article
Nellis, JR; Drysdale, ND; Evans, MA; Habermann, AC; Meza, JM; Andersen, ND; Daneshmand, MA; Turek, JW
Published in: Innovations (Phila)
2021

OBJECTIVE: The benefits of minimally invasive adult cardiac surgery are well established. Nevertheless, minimally invasive congenital cardiac procedures, even for adult patients, are uncommon. In 2018, we started repairing anomalous aortic origin of a coronary artery (AAOCA) through a 5 cm anterior minithoracotomy when possible to improve cosmesis and avoid sternal precautions. We hypothesized this approach was safe and reliable. METHODS: A 5 cm incision was made in the right second intercostal space. The incision was carried down to the pericardium while preserving the internal mammary artery. With the pericardium in view, the second and third ribs were disarticulated. Central cardiopulmonary bypass was established, and the repair was carried out based on the patient's anatomy. The technique was modified to a left anterior minithoracotomy for 1 patient who required pulmonary artery translocation. At any point, if the dissection or repair was not progressing appropriately, the minimally invasive exposure was converted to a partial or traditional median sternotomy. RESULTS: Between June 2018 and June 2019, 11 patients underwent minimally invasive anomalous coronary repair. Four patients (3 with body mass index >30) were converted to traditional sternotomy due to poor visualization. Postoperatively, 1 patient required coronary artery bypass after 335 days, due to extensive collaterals and stable angina. Otherwise, at a median follow-up of 437 days (IQR 340 to 480), patients had resumed baseline activity without recurrent symptoms. CONCLUSIONS: Minimally invasive AAOCA repair may be appealing, although surgeons should be cautious given the high conversion rate.

Duke Scholars

Published In

Innovations (Phila)

DOI

EISSN

1559-0879

Publication Date

2021

Volume

16

Issue

5

Start / End Page

480 / 484

Location

United States

Related Subject Headings

  • Thoracotomy
  • Respiratory System
  • Minimally Invasive Surgical Procedures
  • Mammary Arteries
  • Humans
  • Coronary Vessels
  • Coronary Artery Bypass
  • Aorta
  • Adult
 

Citation

APA
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ICMJE
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Nellis, J. R., Drysdale, N. D., Evans, M. A., Habermann, A. C., Meza, J. M., Andersen, N. D., … Turek, J. W. (2021). Anomalous Aortic Origin of a Coronary Artery Repair Through an Anterior Minithoracotomy. Innovations (Phila), 16(5), 480–484. https://doi.org/10.1177/15569845211031541
Nellis, Joseph R., Nicolas D. Drysdale, Megan A. Evans, Alyssa C. Habermann, James M. Meza, Nicholas D. Andersen, Mani A. Daneshmand, and Joseph W. Turek. “Anomalous Aortic Origin of a Coronary Artery Repair Through an Anterior Minithoracotomy.Innovations (Phila) 16, no. 5 (2021): 480–84. https://doi.org/10.1177/15569845211031541.
Nellis JR, Drysdale ND, Evans MA, Habermann AC, Meza JM, Andersen ND, et al. Anomalous Aortic Origin of a Coronary Artery Repair Through an Anterior Minithoracotomy. Innovations (Phila). 2021;16(5):480–4.
Nellis, Joseph R., et al. “Anomalous Aortic Origin of a Coronary Artery Repair Through an Anterior Minithoracotomy.Innovations (Phila), vol. 16, no. 5, 2021, pp. 480–84. Pubmed, doi:10.1177/15569845211031541.
Nellis JR, Drysdale ND, Evans MA, Habermann AC, Meza JM, Andersen ND, Daneshmand MA, Turek JW. Anomalous Aortic Origin of a Coronary Artery Repair Through an Anterior Minithoracotomy. Innovations (Phila). 2021;16(5):480–484.

Published In

Innovations (Phila)

DOI

EISSN

1559-0879

Publication Date

2021

Volume

16

Issue

5

Start / End Page

480 / 484

Location

United States

Related Subject Headings

  • Thoracotomy
  • Respiratory System
  • Minimally Invasive Surgical Procedures
  • Mammary Arteries
  • Humans
  • Coronary Vessels
  • Coronary Artery Bypass
  • Aorta
  • Adult