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Minimally Invasive,Multivessel, total arterial, offpump coronary artery bypass surgery through left anterolateral thoracotomy
Anvay Mulay, II, Ashish Gaur, Praveen Kulkarni, Dr, Sandeep Sinha. kokilaben dhirubhai ambani hospital, mumbai, India.
Background: Patients who are long standing diabetic, rheumatoid arthritis , on immunosupressant , on steroids,and osteoporotic, in whom wound healing could be potential problem CABG through anterolateral thoracotomy can give them bilateral internal thoracic conduits or total arterial grafts. We evaluated 70 such selected patients who underwent minimally invasive multivessel total arterial off pump CABG through left anterolateral thoracotomy.
METHODS: The procedure was performed using5-10 cm left anterolateral thoracotomy incision.Lima harvested in every patient, Rima or radial artery used as second conduit. Lima-Rima Y, or Lima -Radial Y was made to accomplish multivessel total arterial bypass grafting.In one patient Saphenous vein was used to graft Lad and Lima used tograft diagonal as Lima length was not adequate.
RESULTS: Multivessel, total arterial CABG was accomplished in all selected individuals. There was no mortality, no reexploration for bleeding and no wound dehiscence or wound infection.Rima was harvested in long standing diabetic patients with no concern for sternal wound healing.In one individual Rsvg used to graft Lad and Lima was used tograft diagonal as lima length was inadequate. In one individual conversion to sternotomy and CPB was required due to unstable hemodynamics.Muscle healing of anterolateral thoracotomy is faster as compared to bone healing of conventional sternotomy incision and patients were back to normal life earlier.
CONCLUSIONS: With local immobilization techniques and conventional instruments minimally invasive multivessel ,total arterial off pump CABG can be accomplished in selected individuals safely. Rima can be harvested in long standing diabetic patients with no concern for sternal wound healing . Muscle healing of anterolateral thoracotomy is faster as compared to bone healing of conventional sternotomy incision and patients are back to normal life earlier.Also MIDCAB can be salvage procedure for TECAB. So if we have to do TECABS tomorrow we have to do MIDCABS today
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