Ascending Aorta Exposure for Proximal Anastomosis in Midcab - A Novel Technique
Apollo Gleneagles Kolkata, Kolkata, India
Ascending Aorta exposure for proximal anastomosis in MIDCAB - a novel technique
Background : Proximal anastomosis have traditionally been a very challenging step in Minimally Invasive CABG. Exposure of the ascending aorta and placement of a sideclamp has posed a technical complexity to the Minimally Invasive cardiac surgeons.We present a novel technique to facilitate proximal anastomosis in MIDCAB :
Methods :1. Pericardiotomy : An oblique U shaped pericardiotomy along the long axis of the heart parallel to the LAD stopping short of the diaphragm2. 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 gauze4. Dissection of the Aorto-pulmonary fold : The Aorto-pulmonary septum is dissected and a stay suture is taken on the sputum and pulled down
Results : All 4 manoeuvres pull the aorta downwards and leftward thus facilitating the application of a sideclamp and potentiates the ease of performing proximal anastomosis.
Conclusions : Improved access to the ascending Aorta for proximal anastomosis encourages surgeons to perform multivessel MIDCAB