Xiphoid lower-sternotomy approach for multivessel revascularization of the left internal mammary artery to the left anterior descending artery and right internal mammary artery inflow to the other vessels.
BACKGROUND
We describe the technical details and the preliminary results of a new surgical approach for multivessel disease that involves using a lower T sternotomy, grafting of the left internal mammary artery (LIMA) to the left anterior descending coronary artery (LAD) and use of the right internal mammary artery (RIMA) as inflow to the other vessels.


METHODS
The sternotomy was made from the xiphoid up to the fourth intercostal space and then was continued transversally (T incision). The LIMA was harvested for a length of approximately 8 cm, with preservation of the distal part. The vein was simultaneously taken from the leg. The RIMA was dissected for a length of approximately 5 cm, and the distal part was occluded. Then, 3 mg/kg heparin was given. The anastomosis between the vein and the RIMA was performed. The distal venous anastomoses were done either singly or sequentially. The anterior or posterior route was chosen according to the patient's anatomy. The LIMA was then anastomosed to the LAD. One drain was placed. The sternum was closed with 4 wires, 2 for the T incision and 2 for the sternum.


RESULTS
Between September and December 2008, 9 patients underwent their operations with this technique. The mean age was 60 years (range, 55-68 years). The mean number of grafts was 2.8. The mean hospital stay was 5.2 days. Operative mortality was 0%. All patients were reevaluated with 16-slice multislice computed tomography, and all grafts were patent. At the 3-month follow-up, all patients were alive and free of symptoms.


CONCLUSIONS
This minimally invasive technique is a useful alternative for complete revascularization. The sternal mammary supply and the upper part of the sternum are preserved.
Benetti Foundation, Rosario, Argentina. federicobenetti@hotmail.com
Federico
F
Benetti
Sotirios
S
Prapas
Ernesto
E
Angeletti
Jose Luis
JL
Ameriso
Eduardo
E
Cicalle
Tomislav
T
Klokocovnik
Ivan
I
Knezevic
Borut
B
Gersak
D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods*; D001807:Blood Vessel Prosthesis; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery*; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000295:instrumentation / Q000379:methods*; D010865:Pilot Projects; D056346:Sternotomy / Q000379:methods*; D048029:TNF Receptor-Associated Factor 6; D016896:Treatment Outcome; D014989:Xiphoid Bone / Q000601:surgery
D048029:TNF Receptor-Associated Factor 6