Off-bypass coronary bypass grafting via minithoracotomy using mechanical epicardial stabilization

Minimally or less invasive surgical coronary revascularization has gained increasing interest along with new techniques and devices designed for easier and safer procedures. Until recently, it appeared questionable whether grafting techniques with avoidance of cardiopulmonary bypass techniques would...

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Bibliographic Details
Published in:	The Annals of thoracic surgery Vol. 63; no. 6; pp. S79 - S83
Main Authors:	Cremer, Jochen, Strüber, Martin, Wittwer, Thorsten, Ruhparwar, Arjang, Harringer, Wolfgang, Zuk, Janosz, Mehler, Doron, Haverich, Axel
Format:	Journal Article Conference Proceeding
Language:	English
Published:	New York, NY Elsevier Inc 01-06-1997 Elsevier Science
Subjects:	Biological and medical sciences Cardiology. Vascular system Cardiopulmonary Bypass Coronary Angiography Coronary Artery Bypass - instrumentation Coronary Artery Bypass - methods Coronary heart disease Female Heart Humans Internal Mammary-Coronary Artery Anastomosis - instrumentation Internal Mammary-Coronary Artery Anastomosis - methods Male Medical sciences Middle Aged Minimally Invasive Surgical Procedures - instrumentation Minimally Invasive Surgical Procedures - methods Postoperative Complications Thoracotomy - methods Vascular Patency Human Treatment Aortocoronary Bypass Surgery Non invasive method General anesthesia Cardiovascular disease Coronary heart disease Result
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Summary:	Minimally or less invasive surgical coronary revascularization has gained increasing interest along with new techniques and devices designed for easier and safer procedures. Until recently, it appeared questionable whether grafting techniques with avoidance of cardiopulmonary bypass techniques would allow adequate results compared with conventional techniques using cardioplegic arrest. Since June 1996, minimally invasive direct coronary artery bypass grafting procedures without cardiopulmonary bypass were intended in 24 patients (19 male, 5 female; age, 60.5 ± 10.5 years) applying a special system (CardioThoracic Systems, Inc) for internal mammary artery access and epicardial surface stabilization approaching through an anterolateral minithoracotomy. Neither video-assisted preparation nor additional pharmacologic stabilization was applied. Concomitant risk factors and associated comorbidity were frequent. The procedure was completed in 23 patients, grafting the left anterior descending coronary artery (n = 21) or diagonal branches (n = 3, 1 sequential) as scheduled. In 1 case with internal mammary artery dissection, cardiopulmonary bypass and sternotomy became necessary. Simultaneous carotid endarterectomy was performed in 1 patient. There were two episodes of intraoperative ventricular fibrillation; no other major complications occurred. Postoperative evaluation was obtained in 16 patients (15 by angiography, 1 by Doppler echocardiography) so far and revealed adequate graft function and patency. Using specially designed instruments for internal mammary artery access and epicardial surface stabilization, minimally invasive direct coronary artery bypass grafting procedures via a minithoracotomy avoiding cardiopulmonary bypass techniques may be applied safely and successfully, even in increased risk constellations.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0003-4975 1552-6259
DOI:	10.1016/S0003-4975(97)00338-X