Please use this identifier to cite or link to this item: https://scholarbank.nus.edu.sg/handle/10635/209876
Title: Setting Up An Integrated, Customized Minimally Invasive Coronary Artery Bypass Program: When To-⋯And When Not To
Authors: Kofidis, Theodoros 
Hu, Peggy 
Swee, Kang Giap
Chang, Guhao
Kah, Ti Lian
Sazzad, Md Faizus 
Lee, CN
Issue Date: 6-Dec-2019
Publisher: INTERNATIONAL CORONARY CONGRESS
Citation: Kofidis, Theodoros, Hu, Peggy, Swee, Kang Giap, Chang, Guhao, Kah, Ti Lian, Sazzad, Md Faizus, Lee, CN (2019-12-06). Setting Up An Integrated, Customized Minimally Invasive Coronary Artery Bypass Program: When To-⋯And When Not To. 5th International Coronary Congress, State of the art: Surgical Coronary Revascularization. ScholarBank@NUS Repository.
Abstract: OBJECTIVE: In an Academic Center of Excellence (ACE) in Asia, with a multi-ethnic patient cohort, which is plagued with diabetes, HF, and a general aversion against open surgical procedures, we established a variable Minimally Invasive Coronary Artery bypass program. Here we survey upon techniques used, their differentiated implementation, and caveats. METHODS: Starting with MIDCAB, EVH and ERH, we proceeded to establish a personalized quiver, including Minimally Invasive multi-vessel procedures (Beating and Arrested-Heart), as well as two-stage- and same-stop hybrid procedures, adapted to the needs of our patients Postoperative data are captured, as are primary and secondary treatment benefits. Training aspects (in situ and in-silico) as well as limiting conditions and contraindications were captured. RESULTS: Our variable MICS CABG program has proven a powerful tool in treating patients with all stages of surgical CAD. It provides the freedom to adjust the procedure to the needs of the patient, and creates a platform of closer collaboration with the Cardiologists At the core of the program stands the MICS multi-vessel CABG, both using SVGs as well as Arterial grafts. The patients’ main concern is speedy recovery and full refunctionalization, which MICS CABG is able to provide, with shorter hospital stay, higher postop Hb, serum albumin, higher mobility, less infections and an overall higher-value patient journey, without cost increments. There are conditions that should deter from performing MICS CABG, such as severe COPD, severe aortic and peripheral calcifications, and complex, diffuse disease with LM involvement and very low EF. Our program is comprehensive, structured, scalable and trainable, both in-silico and in-situ. CONCLUSIONS: MICS CABG is within the trends of the time (Value-Based Outcomes) and provides a variable armamentarium to address individual patients needs, at no additional cos, compared with traditional CABG. Extreme anatomical and comorbid conditions must be carefully addressed.
Source Title: 5th International Coronary Congress, State of the art: Surgical Coronary Revascularization
URI: https://scholarbank.nus.edu.sg/handle/10635/209876
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