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Bilateral Internal Thoracic Artery Harvesting With Video Thoracoscopy For Minimally Invasive Anaortic Coronary Artery Bypass
Ilhan Mavioglu, MD1, Ergun Demirsoy, M.D.
2;
1Private Practice, Istanbul, Turkey,
2Kolan International Hospital, Istanbul, Turkey
BACKGROUND: Preparing the left internal thoracic artery (ITA) throughout its length is the gold standard for minimally invasive coronary artery bypass surgeries, which we encounter more and more frequently. It is also predicted that using both ITAs will provide better long-term results. Video-assisted thoracoscopy (VAT) may ease the bilateral ITA harvesting, creating less trauma and better visualization.
METHODS: A camera port was placed at the midclavicular level in the 4th intercostal space. A port for endoscopic surgical instruments was placed at the 2nd and 6th intercostal space at the anterior axillary level.
The carbon dioxide flow from the camera port at a pressure of 8-12 mmHg was adjusted by observing the patient's blood pressure. Harvesting was done using endoscopic surgical instruments, a dacron tape sling, and a harmonic sealing device.
RESULTS: A good pulsatile flow was present in both ITAs. Both ITAs can be safely harvested with the help of VAT.
CONCLUSIONS: The VAT method to ensure adequate length preparation of both ITAs for Minimally invasive Anaortic Coronary Artery Bypass (MACAB) made it possible to prepare bilateral ITAs with less trauma.The development of suitable simulation systems and perhaps the use of 3D cameras will ensure that this method, which provides less traumatic and more extended graft harvest, will become widespread, especially by enabling cardiac surgeons to get used to endoscopic procedures.
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