The Total Arterial Minimally Invasive Revascularization Via Antero Lateral Mini Thoracotomy. A Step By Step Instruction On How To Do
Marc Albert, Adrian Ursulescu, Ulrich FW Franke.
Robert-Bosch-Hospital, Stuttgart, Germany.
Off-pump total-arterial multi-vessel myocardial revascularization allows improved results regarding mortality and neurological outcome. Similar to other cardiac procedures, a minimally invasive approach has been developed within the last years using an antero-lateral access, but the techniques used in the different centers vary widely. This article describes the surgical technique to perform a minimally invasive off-pump procedure using the left internal thoracic artery and an endoscopically harvested radial artery as well as the standard off-pump equipment.
Since August 2008 more than 500 patients received a minimally invasive, total arterial multi-vessel revascularization via an antero-lateral thoracotomy in our department. In all patients, the left internal mammary artery (LIMA) was used. Additionally, one radial artery was harvested endoscopically afterward for the use as a T-graft originated into the LIMA. This presentation will show a step-by-step instruction on how to perform the positioning and stabilization of the heart in order to reach all three target areas.
Although this technique is challenging for the surgeon at first, it has a steep learning curve, the patients have a significantly improved quality of life and the MACCE rate is lower compared to the appropriate rate of OPCAB revascularization via median sternotomy published in the literature.
The technique described here for the minimally-invasive total-arterial multi-vessel revascularization via an antero-lateral mini-thoracotomy is feasible and safe. The learning curve for this challenging technique is significant, but surgeons need about 50 cases in order to establish this technique as a routine alternative to the conventional median sternotomy.
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