First in Romania: complete coronary revascularization without cutting the sternum, performed at MONZA ARES
A complete coronary revascularization intervention, carried out without sternum sectioning, was performed for the first time in Romania, at MONZA ARES, by a team coordinated by Dr. Stanislav Rurac, primary physician in cardiovascular surgery. The procedure, called TCRAT, allows a complete heart bypass to be performed through an incision between the ribs and can significantly shorten the recovery period of patients with severe coronary artery disease.
For many patients, the idea of a bypass operation is related to one of the most difficult images in cardiac surgery: opening the sternum. Recovery is long, postoperative restrictions are important, and returning to daily life can take months.
At MONZA ARES, a technique was applied that changes this approach. It is total coronary revascularization by left anterior thoracotomy, known as TCRAT, a procedure that allows a complete bypass to be performed without opening the sternum.
The method was developed and perfected by surgeon Oleksandr Babliak from Kiev, one of the pioneers of microinvasive cardiac surgery. For the implementation of the technique in Romania, he was present at MONZA ARES and directly assisted the first interventions, together with the local team.
“We can achieve a complete coronary revascularization through a microinvasive approach, without changing the surgical indication and without abandoning the principles of classic bypass. The difference is that we avoid the sternotomy,” explains Dr. Stanislav Rurac.
What exactly does this intervention mean?
Coronary artery disease is one of the leading causes of death worldwide. When the coronary arteries are severely damaged, one of the therapeutic solutions is the aorto-coronary bypass, an intervention through which the blood is redirected to bypass the blocked areas.
Typically, this operation is done through a sternotomy, that is, by opening the sternum. TCRAT changes the approach: the surgeon reaches the heart through an intercostal incision, without sectioning the sternum.
The difference is especially important for recovery. Without sternotomy, the patient mobilizes faster, spends less time in the hospital and avoids one of the most feared complications of classical surgery, mediastinitis.
“The major benefit is not only the fact that the incision is smaller. Eliminating the sternotomy means reducing the complications associated with classic surgery, especially the risk of mediastinitis, but also a faster recovery and an earlier resumption of usual activities,” says Dr. Stanislav Rurac.
The first cases operated on in Romania, at Monza Hospital
The first interventions performed using this method were performed on three patients aged 40, 62 and 83. All had severe coronary artery disease, with damage to several important vessels of the heart, and required a triple bypass, that is, an intervention by which three affected coronary arteries were bypassed.
The cases were by no means simple. One of the patients had recently undergone a heart attack and associated obesity. The 62-year-old patient had also been diagnosed after a recent coronary event. The 83-year-old patient also had chronic obstructive pulmonary disease, which made respiratory recovery more difficult.
However, the interventions had a favorable evolution. Two of the patients stayed in intensive care for only 24 hours and were discharged within 5–6 days. In the case of the elderly patient, hospitalization was influenced by the associated pulmonary pathology, not by the occurrence of major cardiac complications.
Why this premiere is important
The majority of bypass interventions in Romania and in many centers around the world continue to be performed through sternotomy. Microinvasive techniques have existed until now, but most of the time they were reserved for more limited cases.
However, TCRAT extends microinvasive surgery to patients who need complete revascularization, including more complex forms of coronary disease.
“From the point of view of the indication, we are not talking about an intervention reserved only for exceptional cases. Patients who have an indication for classic aorto-coronary bypass can also benefit from this approach, when there is the necessary experience in the surgical team,” says Dr. Rurac.
The implementation of the technique at MONZA ARES comes on the back of an already substantial experience in microinvasive cardiac surgery. This very basis allowed the transition to a more complex procedure, now applied for the first time in Romania.
For patients, the difference can mean less surgical trauma, fewer complications and a faster return to daily life. For cardiac surgery, it may pave the way to a new standard.
Article supported by MONZA ARES
