Port-access coronary artery bypass with cardioplegic arrest: acute and chronic canine studies.
BACKGROUND
Our goal is to perform minimally invasive coronary artery bypass grafting without sacrificing the benefits of myocardial protection with cardioplegia.


METHODS
Twenty-three dogs underwent acute studies and 4 dogs underwent survival studies. The left internal mammary artery was taken down using a thoracoscope. Cardiopulmonary bypass was conducted via femoral cannulas and using an endovascular balloon catheter for ascending aortic occlusion, root venting, and delivery of antegrade blood cardioplegia. Pulmonary artery venting was achieved with a jugular vein catheter. An internal mammary artery-to-coronary artery anastomosis was performed using a microscope through a 10 mm port.


RESULTS
All animals were weaned from cardiopulmonary bypass in sinus rhythm without inotropes. Cardiopulmonary bypass duration was 104 +/- 28 minutes and aortic clamp duration was 61 +/- 22 minutes. Cardiac output and pulmonary artery occlusion pressure were unchanged. The internal mammary artery was anastomosed to the left anterior descending artery (25) or the first diagonal (2) with patency shown in 25 of 27. One dog in the survival study had a very short internal mammary artery pedicle under tension and was euthanized for excessive postoperative hemorrhage. Three weeks postoperatively the remaining dogs had angiographically patent anastomoses, normal transthoracic echocardiograms, and histologically normal healing and patent grafts.


CONCLUSIONS
Endovascular cardiopulmonary bypass using a balloon catheter is effective in arresting and protecting the heart to allow thoracoscopic internal mammary artery-to-coronary artery anastomosis.
Stevens
J H
JH
Department of Cardiothoracic Surgery, Stanford University School of Medicine, California, USA.
Burdon
T A
TA
Siegel
L C
LC
Peters
W S
WS
Pompili
M F
MF
St Goar
F G
FG
Berry
G J
GJ
Ribakove
G H
GH
Vierra
M A
MA
Mitchell
R S
RS
Toomasian
J M
JM
Reitz
B A
BA
D000818:Animals; D001769:Blood; D002302:Cardiac Output; D002314:Cardioplegic Solutions / Q000008:administration & dosage; D002315:Cardiopulmonary Bypass; D002404:Catheterization / Q000295:instrumentation*; D002405:Catheterization, Central Venous / Q000295:instrumentation; D002406:Catheterization, Peripheral / Q000295:instrumentation; D002408:Catheters, Indwelling; D017023:Coronary Angiography; D004285:Dogs; D004452:Echocardiography; D006324:Heart Arrest, Induced; D006339:Heart Rate; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000295:instrumentation / Q000379:methods*; D007601:Jugular Veins; D019060:Minimally Invasive Surgical Procedures; D019106:Postoperative Hemorrhage / Q000209:etiology; D011651:Pulmonary Artery; D011669:Pulmonary Wedge Pressure; D015996:Survival Rate; D020708:Thoracoscopes; D013997:Time Factors; D014654:Vascular Patency; D014945:Wound Healing
D002314:Cardioplegic Solutions