Minimally Invasive Coronary Artery Bypass Grafts Safely And Easily Done Using Only Vessel Stabilizer, Without Heart Positioner
Pervaiz A. Chaudhry, MD.
Community Regional Medical Center, Fresno, CA, USA.
Objective: Minimally invasive, off pump, CABG is simpler and easier using only a vessel stabilizer without the use of heart positioner. By eliminating the heart positioner, there is more space to navigate, and less trauma to the heart created from applying positioner and helps in hemodynamic stability.
Methods: To evaluate the functionality of this technique, we reviewed the last 100 minimally invasive, CABG cases (Elective 53, Urgent 47). Between one and six grafts were done with average of 2.6 grafts, per patient. All operations were started via left mini anterior thoracotomy. Two case were converted to open chest and two cases required CPB support.
All operations were done with the use of vessel stabilizer. Only sub-xiphoid incision was made for vessel stabilizer. For large hearts, 2nd vessel stabilizer was used through the incision for RCA, PDA and PL grafting.
Results: Three patients died before discharge, only one with surgical mortality. Two patients had renal failure and no patients had stroke. Average length of stay was 9 days. This result was somewhat skewed; excluding 3 long term patients, average length of stay was 4.9 days. Majority of patients reported to be pain free at discharge and able to resume their regular daily activities including returning to work within two weeks due to cryoablation of two involved intercostal nerves.
Conclusion: Minimally invasive, complete cardiac revascularization is possible, reproducible and easier by using only a vessel stabilizer. Next generation instruments will further help to make this procedure standard of care.
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