Surgical Results Of Multi Vessel Off Pump Mics Cabg Under Direct Vision
Ichinomiya-Nishi Hospital, Ichinomiya-Nishi, Japan.
Surgical Results of multi vessel off-Pump MICS CABG under direct vision BACKGROUND We have started MICS CABG program from 2012 and had started using BITA from 2014. So far we also have developed our original technique of MICS CABG, such as harvesting BITA with Harmonic Scalpel and displacement of the heart for off pump technique in MICS CABG. METHODS Consecutive112 patients who underwent multi vessel off pump MICS CABG in 140 cases of MICS CABG done by a single surgeon between February 2012 and August 2017 were reviewed retrospectively. The patient is positioned in right lateral decubitus position. After 8-10 cm left lateral small thoracotomy, the mediastinal space is dissected beneath the sternum until the right lung is visualized. Then right internal thoracic artery and/or left internal thoracic artery are harvested using an octopus NUVO stabilizer and a 32cm harmonic scalpel with skeletonised fashion under direct vision. Then proximal anastomosis was made on the ascending aorta with the flexible side biting clump. Three deep pericardial sutures are placed like OPCAB fashion to assist displacement of the heart for distal anastomosis. Distal anastomoses were done with usual suction type tissue stabilizer. RESULTS Total 112 cases of multi vessel off pump MICS CABG were performed via a left thoracotomy incision were done. The harvesting RITA was attempt in 52 cases without major complications during RITA harvesting. All BITA was used in 52 cases. There was no conversion to sternotomy, cardiopulmonary bypass was used in one case. The average number of distal anastomoses was 3.1 ± 0.9. Proximal anastomosis on the ascending aorta was done in 74 cases without any problem. There was no stroke and no in-hospital mortality. Mean duration of the operation was 279.3 ± 79.8 minutes. Mean duration of ICU length of stay was 2.8 ± 2.4 days. CONCLUSIONS Multi vessel off pump MICS CABG via left small thoracotomy under direct vision were done safely with several new techniques. MICS CABG using BITA may have possibility to be a standard revascularization in coronary surgery.
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