Multivessel, all-arterial, off-pump surgical revascularization without disruption of the thoracic skeleton.
OBJECTIVE
To evaluate the feasibility of performing multivessel off-pump surgical revascularization without manipulation of the thoracic cage.


METHODS
The technique consists of bilateral thoracoscopic internal mammary artery harvesting followed by a nonrib-spreading, muscle-sparing opening in the soft tissue of the thorax. An endoscopic cardiac positioner and stabilizers exposes and steadies the target arteries beneath a small opening. Anastomoses are constructed off-pump through the natural width of the intercostal space without the need for rib spreading.


RESULTS
Fifty-two patients underwent all-arterial, off-pump revascularization through incisions avoiding manipulation of the thoracic skeleton. The mean number of grafts per patient was 2.2 +/- 0.4. Transit time flow measurements verified graft patency before closure in all cases. The mean operating time was 4.4 hours (range, 3.4 to 5.6). Hospital length of stay was 2.6 +/- 1.9 days. There was no early or late mortality. Postoperative angiography performed in 63.8% of the grafts (74 of 116) revealed an overall patency rate of 98.6%.


CONCLUSIONS
A grafting approach that avoids any manipulation of the thoracic skeleton offers significant patient value and may not be limited to single-graft cases.
Pensacola Heart Institute, Pensacola, Florida, USA. thomas_vassiliades@emoryhealthcare.org
Thomas A
TA
Vassiliades
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome