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Hemi-Sternotomy Approach For Off Pump Coronary Artery Bypass Grafting (OPCAB - HS), The New Minimally Invasive Direct Coronary Artery Bypass Grafting (MID CAB)?
Gary S. Allen, M.D., David Corda, M.D., Michael Arizola, PA, Tuwana Phelps-keaton, RN.
Florida Hospital Waterman, Tavares, FL, USA.

OBJECTIVE: Minimally invasive direct coronary artery bypass grafting (MIDCAB) through a left thoracotomy has several shortcomings. Among them are significant wound pain, limited grafting targets, reduced graft patency, and poor adaptability. We report our early experience with OPCAB through a partial sternotomy for multivessel disease to assess safety and feasibility
METHODS: From March 2012 to June 2012 twenty-eight consecutive patients underwent OPCAB via an “L” shaped lower sternotomy incision through the third intercostal space. Tissue stabilization was achieved via port access and using the Medtronic Endooctopus system (Medtronic, Minneapolis, MN). Proximal anastomosies were performed with the Heartstring III proximal seal system (MAQUET, Wayne, NJ).
RESULTS: The mean age was 68.3 years with 21 (75%) male patients. There were no conversions to full sternotomy or to an “on pump” technique. Patients received an average of 2.7 grafts (range 1 to 5) of which one was single, 10 were double, and 17 were three or more grafts. Mean operating time was 194.6 min + 59.1 (STDEV). All intended targets were successfully grafted. Three (10.7%) patients received a red blood cell transfusion. Seven (25%) patients required temporary inotropic support. Mean extubation time was 5.7 hr + 4.1. There was no 30 day mortality. There were no postoperative myocardial infarctions, cerebrovacular accidents, or graft revisions.
CONCLUSIONS: Limited target access, graft inaccuracies and a slow learning curve have limited the adoption of MIDCAB. Our early experience with a partial sternotomy approach to OPCAB employs easily adaptable surgical techniques allows unobstructed visualization of all grafting territories while adding only a small increase to operating time. OPCAB-HS is safe, feasible and may offer similar benefits to other small incision approaches


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