International Society for Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Bilateral Internal Thoracic Artery Configurations For Complete Myocardial Revascularization: Computed Tomography Data
Vidadi Efendiev1, Mikhail Snegirev1, Evgeniy Minin1, Vladimir Noginov1, Vladimir Shmyrev1, Timur Ruzmatov2.
1Mariinsky hospital, Saint-Petersburg, Russian Federation, 2Friendly Society Private Hospital, Bundaberg, Australia.

BACKGROUND: Minimally invasive coronary bypass grafting in its various modifications is practiced worldwide. Nevertheless, harvesting of both internal thoracic arteries (ITA) is still occasionally performed by the most experienced and focused groups. In this study, we demonstrate how left and right mammaries may be configured in order to achieve full arterial revascularization by two ITAs via the left minithoracotomy.
METHODS: Between May 2018 and December 2023 we have operated on 162 patients for whom both left and right ITAs were harvested through small left-side intercostal incision. Operations were conducted off-pump. In order to verify patency of the grafts CT-angiography was selectively performed at least 6 months after the operation. We avoided bilateral ITA harvesting in morbidly obese patients and patients with severe heart enlargement.
RESULTS: All patients received full myocardial revascularization. In 143 patients full revascularization was achieved only by ITA grafts. In 68 cases ITAs were used as in situ grafts where right ITA (RITA) revascularized LAD system and left ITA (LITA) anastomosed to the left-sided branches. In the remaining 75 cases we harvested RITA as a free graft and used it as a Y-graft with LITA. In this scheme, RITA length was usually enough to graft circumflex branches sequentially and even reach PDA. In 9 cases when RITA length was scarce we used additional venous or radial conduits. The overall number of the patients who underwent postoperative CT coronary evaluation was 18. Median follow-up was 18.3 11.2 months. Among 46 investigated grafts only 2 had signs of dysfunction. Thus, the patency rate was 95.6 %. The length of the operations was 219 63 minutes. There was no perioperative mortality in this series.
CONCLUSIONS: Complete arterial revascularization with bilateral ITA may be routinely achieved via the minithoracotomy. Y-graft configuration with sequential anastomoses allows all targets to be grafted in almost every case.LEGEND: CT-angiographic assessment of bilateral ITA patency. LITA-LAD and Y-graft RITA-diagonal-obtuse marginal configuration is demonstrated.


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