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International Society For Minimally Invasive Cardiothoracic Surgery

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Ascending Aorta Exposure For Proximal Anastomosis In Midcab - A Novel Technique
Tamashis Mukherjee.
Apollo Gleneagles Hospital, Kolkata, India.

Ascending Aorta exposure for proximal anastomosis in MIDCAB - a novel technique
Dr. Tamashis Mukherjee, Dr. Vinod Kumar, Dr. Sushan Mukhopadhyay
Proximal anastomosis have traditionally been a very challenging step in Minimally Invasive CABG. Exposure of the ascending aorta and placement of a side-clamp has posed a technical complexity to the Minimally Invasive cardiac surgeons.
We present a novel technique to facilitate proximal anastomosis in MIDCAB :
1. Pericardiotomy : An oblique U shaped pericardiotomy along the long axis of the heart parallel to the LAD stopping short of the diaphragm
2. Herniation of the heart : The heart is lifted from the pericardium and herniated into the left hemithorax. This drags the ascending aorta to the left and downwards thus improving the access.
3. Packing the groove between aorta and SVC with a gauze
4. Dissection of the Aorto-pulmonary fold : The Aorto-pulmonary septum is dissected and a stay suture is taken on the sputum and pulled down
All 4 manoeuvres pull the aorta downwards and leftward thus facilitating the application of a sideclamp and potentiates the ease of performing proximal anastomosis.

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