Novel Techniques For Displacement Of The Heart In Off-pump Minimally Invasive Coronary Artery Bypass Grafting
Taichi Sakaguchi, Masaaki Ryomoto, Naosumi Sekiya, Hiroe Tanaka, Mitsuhiro Yamamura
Hyogo College of Medicine, Nishinomiya, Japan
Objective: Proper positioning of the heart via a small left thoracotomy is the main challenge during off-pump minimally invasive coronary artery bypass grafting (MICS CABG). Here we report a novel technique for target vessel exposure using a new multi-suction heart positioner. Methods: The both right and left internal thoracic arteries (RITA and LITA) were harvested from the left minithoracotomy under direct vision. The distal RITA was extracted outside the thorax through a small hole made in the right second intercostal space. The RITA was extended by anastomosing the radial artery (RA) graft to create an I-composite graft, which was re-introduced into the chest cavity for later use. Then, the distal anastomoses were performed as follows, the LITA to the left anterior descending artery (LAD), the RA to the first diagonal branch (D1), and the RA to the postro-lateral branch (PL). Results: Off-pump an-aortic MICS CABG (LITA-LAD, RITA-RA-D1-PL) was successfully performed. For displacement of the heart, a multi-suction heart positioner was useful because the small suction cups can be attached to the heart one by one; thus, stepwise displacement of the heart can be achieved. In addition, the flexible traction cords can be pulled toward any direction via either the main thoracotomy or another hole. This armless design facilitates appropriate positioning of the heart. Conclusions: This multisuction heart positioner enables the use of flexible exposure techniques and contributes to the safety and feasibility of multivessel MICS CABG.
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