International Society For Minimally Invasive Cardiothoracic Surgery

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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.

Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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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