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minimally invasive sternal sparing direct ascess coronory artery bypass grafting
Vikram Goyal, DR1, ALOK MATHUR1, DEEPIKA MISHRA2.
1Jaipur Heart Institute, Jaipur, India, 2SMS MEDICAL COLLEGE, Jaipur, India.

Introduction:
The morbidity of the conventional Coronary artery bypass grafting (CABG) has been the major drawback in competing with other revascularization techniques. Over the last decade, attempts at robotic and endoscopic sternal sparing approaches have met with limited success due to prohibitive cost and lack of reproducibility. We propose the middle path of a direct sternal sparing approach through a small (3.5 inches) left thoracotomy for multi-vessel revascularization and present our experience of 100 cases..
Methods:
Exclusion criteria were ,distal LAD disease,unstable patient and chronic obstructive pulmonary disease,. Chest is entered through fourth intercostal space using a 3.5 inch incision. LIMA is dissected under direct vision using specially designed retractors. For CPB assisted patients, femoral artery and vein are cannulated. proximal anastomosis is next constructed under direct vision on the aorta..
Results:
100 patients underwent CABG through a small left thoracotomy between June 2010 and August 2012. 27 had single, 42 had double and 31 had triple vessel disease. Femoral cardio-pulmonary bypass was used in 58 patients and rest had off pump surgery. The men age was 64±6 years. Fifty eight percent were diabetic. The mean number of grafts were 2.4±0.7. The average blood transfusion requirement was 1.1±0.8 units. The mean intensive unit stay was 2.1±1.3 days. The mean hospital stay was 4.5±2.3 days. There were no deaths or wound infection.
Conclusion:
Minimally invasive, sternal sparing direct surgical revascularization combines the benefit of a direct vision good anastomosis with the morbidity of percutaneous intervention. It is safe, reproducible and cost-effective due to shortened intensive care and hospital stay.


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