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Non-robotic closed chest TECAB in a porcine animal model - a videopresentation
Hagen Gorki1, Jun Liu1, Frank Poelzing2, Susanne Gorki3, Heidi Pasche2, Guenter Albrecht1, Andreas Liebold1.
1University of Ulm, Ulm, Germany, 2Institute of Innovative Medicine, Beichlingen, Germany, 3Zentralklinik Bad Berka GmbH, Bad Berka, Germany.

OBJECTIVE: Total endoscopic coronary artery grafting (TECAB) is actually performed exclusively with the help of a telemanipulator. However, the manual approach could become a less expensive minimal invasive alternative with results of comparable quality. To investigate the feasibility an animal study was performed.
METHODS: In a series with 5 domestic pigs, the internal mammary artery was harvested endoscopically. The extracorporeal circulation was established via peripheral vessel access. After intraluminal balloon occlusion of the ascending aorta the anastomosis of the mammary artery and the left anterior descending artery was performed with 7-0 prolene running suture in cardioplegic arrest. As a terminal study, after successful weaning off bypass, the animals were sacrificed and the quality of anastomoses was checked.
RESULTS: With a learning curve for cannulation options, balloon positioning under X-ray control, 3D camera application and usage of new instruments, the coronary anastomosis was performed with improving quality. The operation on the fifth animal is documented in this 2D video.
CONCLUSIONS: With successful performance of coronary anastomoses in a living animal model despite some demanding anatomical differences to humans, the application in patients as a proof-of-concept study could be the next step.

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