Total Coronary Revascularization Via Left Anterior Thoracotomy : Technical Aspects
Volodymyr Demianenko, Oleksandr Babliak.
Diagnostic and Treatment Center For Children And Adults Of The Dobrobut Medical Network, Kyiv, Ukraine.
OBJECTIVE: Since July 2017 we started to perform all multivessel coronary artery bypass grafting (CABG) through the left anterior minithoracotomy using cardiopulmonary bypass (CPB), Chitwood clamp and cardioplegia. We named this technique - total coronary revascularization via left anterior thoracotomy (TCRAT). Hereby we present the key technical aspects of TCRAT.
METHODS: A total of 170 non-selected consecutive patients underwent TCRAT. Patients were placed in supine position with a inflatable pad under left chest. Left anterior 6 to 8 cm thoracotomy was performed in the 4th intercostal space. Left internal mammary artery and other condutis were harvested under direct vision. Peripheral cannulation was used for CPB. Chitwood clamp was intoduced through the 2nd intercostal space and cold blood antegrade intermittent cardioplegia was used every 15 minutes. Aorta, inferior vena cava and left pulmonary veins were encircled separately with tapes. Pulling the tapes, pulling the Chitwood clamp, rolling the heart and creating the positive end-expiratory pressure in the right lung were used alone or in combination with each other to improve the exposure of all distal coronary targets.
RESULTS: There were no mortality and no conversion to sternotomy. All coronary targets were exposed and grafted according to the preoperative plan using usual coronary instruments and standard anastomotic technique. The average distance from skin level to coronary anastomoses was 6 cm (range, 4 - 9). The mean number of grafts was 3.1 ± 0.7. The mean total operation time was 258.8 ± 43.9 minutes, CPB time - 135.8 ± 26.6 minutes, aortic cross clamp time - 71.2 ± 19.4 minutes.
CONCLUSIONS: TCRAT could be applied in every patient with isolated coronary artery disease and has the potential to be reproducible and equally effective comparing with conventional CABG technique.
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