title: Thymopericardial augmented encasement for coronary artery bypass graft surgery: a report of 245 cases.
abstract: OBJECTIVE
  : A pedicled prepericardial fat flap was created to augment the pericardial cavity and applied for patients undergoing coronary artery bypass grafting. The efficacy and durability of this method were investigated.
  
  
  METHODS
  : Between July 2005 and November 2008, the present technique was applied for consecutive 245 patients (165 men and 80 women, aged 67 ± 8.3 years) undergoing isolated coronary artery bypass grafting in which 240 (98.0%) were off-pump cases. The left and/or right internal thoracic artery and the gastroepiploic artery were used in 244 and 160 patients, respectively, and the saphenous vein and the radial artery were used in 51 and 10 patients, respectively. Ninety-seven (40.0%) patients had been diabetic, 18 (7.3%) had had chronic renal failure, and three were redo cases. The prepericardial soft tissue, involving the pedicled thymic gland, was dissected en bloc and sewn with pericardiotomies to wrap the heart and the grafts. Angiography or three-dimensional computed tomography was used to assess the intrapericardial pathways of each graft and a long-term durability of the fat pad.
  
  
  RESULTS
  : Early angiography or three-dimensional computed tomography proved that the graft pathways were unaffected by the encasements. Resternotomies in two patients and sternal treatments for infectious dehiscence in two patients were safely achievable. Five-year postoperative computed tomography showed the intact fat pad in the retrosternal space.
  
  
  CONCLUSIONS
  : The present technique can encase the heart not the least jeopardizing each pathway of the grafts, and the durable fat pad functions protectively when the sternotomy is either reopened or infected.
authors.affiliation: From the Department of Cardiovascular Surgery, Tokyo Metropolitan Fuchu Hospital, Tokyo, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Mikio
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nonaka