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Tips And Trick To Access Ascending Aorta For Proximal Anastomosis In Mics Cabg
Keita Kikuchi, Ph.D¹, Hiroki Sakai², Kunihiko Yoshino², Yosyun Sai², Kaito Masuda², Joji Ito²;
¹Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan, ²Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan

Minimally invasive coronary artery bypass grafting (MICS CABG) is becoming popular. Despite advancements that have facilitated proximal anastomosis of the ascending aorta through a left small thoracotomy, certain challenges persist. The difficulty of using a side clamp in MICS CABG is particularly pronounced in patients with atherosclerosis and plaques along the ascending aorta and those with a dilated heart due to diminished cardiac function. We present a cases of MICS CABG performed proximal anastomosis via right small thoracotomy using Heart string. In this presentation, we provide insights that can empower coronary surgeons to become proficient in performing MICS CABG. After harvesting all grafts, the second or third right ICS, assessed using 3DCT, was accessed, and the pericardium incised near the ascending aorta. Additionally, the right lung was deflated and ventilation was switched to the left lung, revealing the ascending aorta was in close proximity to the small right incision. Four traction sutures were attached to the pericardium, and these traction sutures were retracted from the right side of the skin incision and a small wound protector (XXS) was inserted through the right incision to adjust aorta position. A HeartString III (MAQUET Cardiovascular LLC) was used to safely puncture the ascending aorta, followed by anastomosis with the no-touch saphenous vein (NT-SVG) using a 6-0 polypropylene suture.

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