How To Complete Minimally Invasive Coronary Artery Bypass Grafting Without Cardiopulmonary Bypass
Keita Kikuchi, Shinji MIzuta, Kan Kaneko.
Ichinomiya Nishi Hospital, Ichinomiya, Japan.
Background We have started off pump MICS CABG(Minimally invasive coronary artery bypass grafting)from 2012 and bilateral internal thoracic artery (BITA) has been used in MICS CABG from 2014. We intend to do MICS CABG without cardiopulmonary bypass. We would like to share our techniques in MICS CABG. Method After opening the appropriate intercostal space, the Thoratrack retractor is put and retracted toward left ward and cephalad direction. Which provides good surgical field during whole procedure. Before harvesting internal thoracic arteries (ITA), the mediastinal fat tissue which attached to the sternum is cut from the innominate vein to the diaphragm completely until the right internal thoracic artery is visualized. This technique provides better surgical field for distal anastomosis. Before harvesting LITA, the fat tissue and transversus thoracis on the LITA are removed to visualized LITA. ITAs were harvested using a harmonic scalpel via port. Then opening the pericardium completely, the pulmonary artery is retracted to the caudal direction using octopus NUVO stabilizer for proximal anastomosis. During the proximal anastomosis on the ascending aorta, systemic blood pressure should be maintained less than 100 mmHg. Three deep pericardial sutures or armless starfish is used to displace the heart for distal anastomosis. During distal anastomoses, usual suction type tissue stabilizer is used routinely. The knot pusher is used to tie for proximal anastomosis and tying suture to stop bleeding from ITAs, this technique should be familiar for surgeon. Result We have done 172 cases of MICS CABG from 2012 to 2019. We have one case of on pump conversion and no conversion to sternotomy. Conclusion These small techniques make MICS CABG possible and reproducible without cardiopulmonary bypass.
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