title: Off-pump complete revascularization through a left lateral thoracotomy (ThoraCAB): the first 200 cases.
abstract: BACKGROUND
  Conventional coronary bypass surgery is associated with substantial morbidity caused by cardiopulmonary bypass (CPB) and median sternotomy. This report describes an innovative technique to perform complete revascularization through a lateral thoracotomy without CPB (thoraCAB).
  
  
  METHODS
  From February 2000 to April 2001 a total of 200 patients underwent thoraCAB. The patient is positioned with the left side elevated to 45 degrees. A 5- to 6-inch incision is made over the left fourth or fifth intercostal space from just medial to the nipple to the anterior axillary line. The left internal thoracic artery is harvested as a pedicle graft under vision. Proximal anastomoses are first completed on the ascending aorta, followed by the distal coronary anastomoses on the beating heart using a stabilizer. Intercostal nerve freezing is done using a cryoprobe.
  
  
  RESULTS
  Complete revascularization was achieved in all patients. The number of grafts averaged 2.9 +/- 1.08 per patient. One patient (0.5%) died of renal failure. Two patients (1%) were converted to CPB. No strokes were observed. Three patients (1.5%) required prolonged ventilation (>48 hours). Five patients (2.5%) had postoperative bleeding requiring reexploration. Of the patients, 16 (8%) developed new-onset postoperative atrial fibrillation.
  
  
  CONCLUSIONS
  ThoraCAB has been feasible in the vast majority of patients requiring coronary bypass surgery. The prevalence of postoperative atrial fibrillation was low. Postoperative pain maybe lessened with intercostal nerve freezing.
authors.affiliation: Cardiac Surgical Associates of West Texas, Odessa, Texas 79761, USA. ssrivastava@msn.com
authors.forename: Sudhir P
authors.initials: SP
authors.lastname: Srivastava
authors.forename: Kirit N
authors.initials: KN
authors.lastname: Patel
authors.forename: Rajaratnam
authors.initials: R
authors.lastname: Skantharaja
authors.forename: Reyna
authors.initials: R
authors.lastname: Barrera
authors.forename: Diana
authors.initials: D
authors.lastname: Nanayakkara
authors.forename: Vishwa
authors.initials: V
authors.lastname: Srivastava
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006355:Heart-Lung Machine; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009204:Myocardial Revascularization / Q000379:methods; D011183:Postoperative Complications; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D014654:Vascular Patency