Premium
Minimally Invasive Coronary Surgery with Thoracoscopic Internal Mammary Artery Dissection: Surgical Technique
Author(s) -
Nataf Patrick,
Lima Leonardo,
Regan Mary,
Benarim Said,
Pavie Alain,
Cabrol Christian,
Gandjbakch Iradj
Publication year - 1996
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.1996.tb00052.x
Subject(s) - medicine , dissection (medical) , mammary artery , surgery , invasive surgery , thoracoscopy , artery
A bstract Background: We describe our technique of revascularization of the left anterior descending artery (LAD), using the left internal mammary artery (LIMA) without cardio‐ pulmonary bypass (CPB), by means of a 4‐cm left thoracotomy and video‐thoracoscopic harvesting of the LIMA. Methods: The patient is placed in a semioblique position. The LIMA is harvested under thoracoscopic guidance. Trocars are introduced via three thoracic incisions of less than 15 mm at the level of the fourth and seventh intercostal spaces. Perforating arterial branches are cauterized or clipped. This approach allows complete dissection of the LIMA from the subclavian artery to the fifth intercostal space. A 4‐cm left anterior thoracotomy is then made along the fourth or the fifth intercostal space. Rib excision is not necessary for LAD exposure. Coronary artery control is obtained with looping sutures (4/0 prolene) placed proximally and distally to the site of the anastomosis. Anastomosis is then performed with 8/0 prolene on the beating heart, under direct vision, without CPB. Results : Between September 1995 and May 1996, this procedure was performed on 20 consecutive patients under age 80. There were no operative complications. The mean duration of hospitalization was six days. Conclusions : This new procedure enlarges the field of minimally invasive coronary artery bypass grafting techniques.