Abstract 2280: Three Hundred Consecutive Cases of Multi-Vessel Small Thoracotomy (MVST) Coronary Artery Bypass Grafting
Bibliographic record
Abstract
Background: Multi-Vessel Small Thoracotomy (MVST) is a new coronary operation that does not require special infrastructure and is potentially available to all cardiac surgeons. It aims at approaching the minimal invasiveness of percutaneous coronary interventions (PCI) while giving patients the durability of surgical revascularization. We examined the feasibility and safety of MVST in the first large series of this operation to date. Methods and Results: All myocardial territories can be accessed via a 4 – 6cm left 5th intercostal (IC) thoracotomy. An endothoracic apical retractor and epicardial stabilizer are introduced through the subxyphoid and left 7th IC spaces, respectively. The procedure is performed off-pump. The left internal thoracic artery (LITA) is used to graft the left anterior descending (LAD), and radial artery or saphenous vein segments are used to graft the lateral and inferior myocardial territories. Proximal anastomoses are performed from the LITA as a T-graft or directly on the aorta. In the first 300 consecutive MVSTs at our 2 centers, mean age was 61.9±10.7y and 97 patients were female (32%). Diabetes was prevalent in 94 (31%) and previous PCI in 69 (23%). The average number of grafts was 2.1±0.8; 104 patients (34%) had total arterial grafting, and 7 (2.3%) underwent MVST as a hybrid revascularization strategy. There were 12 conversions to sternotomy (4.0%), 7 patients requiring CPB assistance (2.3%), and 3 reinterventions for bleeding (1.0%). Perioperative mortality was 2 patients (0.7%). Respiratory failure occurred in 22 patients (5.3%), atrial fibrillation in 52 (17%), and the median length of stay was 4 days. No stroke or deep wound infection occurred. At a mean follow-up of 19.2±9.4 months, 9 patients (3.0%) had required postoperative coronary interventions, 7 of which were for issues with LITA T-grafts. Only 2 graft failures occurred in the 128 patients with proximal anastomoses onto the aorta (P=0.1 vs. LITA T-grafts). Conclusions: MVST is feasible, safe, and associated with excellent procedural and short-term outcomes. The avoidance of T-grafts from the LITA may optimize long-term patency. The MVST procedure has the potential to make multi-vessel minimally invasive coronary surgery safe, effective, and diffusible.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".