title: Development of a minimally invasive technique for coronary revascularization in a porcine model.
abstract: BACKGROUND
  This porcine model was designed to develop a minimally invasive method for internal mammary artery (IMA) grafting using an anterior mediastinal approach and without routine use of cardiopulmonary bypass.
  
  
  METHODS
  Assessment was made of IMA mobilization through a small parasternal incision, the feasibility of coronary artery grafting with cardiopulmonary bypass using this approach, and conditions for off-pump bypass grafting.
  
  
  RESULTS
  In group 1, 6 pigs underwent IMA mobilization through a 5-cm horizontal midparasternal incision. Of the 2 group 2 pigs, 1 underwent IMA grafting to the left anterior descending coronary artery and the other, bilateral IMA grafting to the left anterior descending and right coronary arteries using femoral-vessel cardiopulmonary bypass. In group 3, 4 of 10 pigs had successful off-pump grafting during retrograde regional coronary venous perfusion of arterial blood. Retrograde coronary venous perfusion could not be established in the other 6 pigs, and attempts at off-pump grafting failed.
  
  
  CONCLUSIONS
  The study demonstrates that coronary artery grafting with the IMA by this minimally invasive off-pump method is feasible, although it draws attention to areas of concern and potential methods of correction. The model provides a realistic and important learning platform for the surgical issues involved with this minimally invasive technique.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, College of Medicine, University of Kentucky, Lexington 40536-0084, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Robinson
authors.forename: D R
authors.initials: DR
authors.lastname: Gross
authors.forename: K A
authors.initials: KA
authors.lastname: Thielmeier
authors.forename: B B
authors.initials: BB
authors.lastname: Hill
authors.forename: W F
authors.initials: WF
authors.lastname: Zeman
mesh_terms: D000818:Animals; D002315:Cardiopulmonary Bypass; D004195:Disease Models, Animal; D005240:Feasibility Studies; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures; D013552:Swine