title: Off-pump coronary artery bypass grafting using skeletonized in situ arterial grafts.
abstract: Skeletonization is an advanced technique of graft harvesting for coronary artery bypass grafting (CABG), and while it requires meticulous attention, it has many advantages. For example, skeletonization of internal thoracic artery (ITA) can minimize sternal ischemia and lower the risk of mediastinitis, and is longer and larger than pedicled ITA. In this article we describe the surgical techniques demonstrated in our video, which details our techniques of skeletonization of arterial grafts and off-pump coronary artery bypass (OPCAB) exclusively using these in situ grafts. Our method of right gastroepiploic artery (GEA) skeletonization has only three technical steps. The first step is to pass thin vessel loops under the GEA. The second step is to unroof the tissue surrounding the GEA. The last step is to seal and sever all the branches. Skeletonization of the GEA not only prevents vasospasm but also leads to GEA dilatation, and facilitates inspection and makes sequential anastomosis easier. Bilateral use of the skeletonized ITA and use of the skeletonized GEA can cover most coronary artery target sites without any manipulation of the ascending aorta. In our consecutive series of over 1,000 patients, the stroke rate was 0.5%. Our method helps to make the technique simple and secure in this technically demanding operation, and we believe that OPCAB with these grafts provides the best possible coronary revascularization.
authors: Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa, Otsu, Shiga, Japan.
authors: Tohru
authors: T
authors: Asai
authors: Tomoaki
authors: T
authors: Suzuki
authors: Hiromitsu
authors: H
authors: Nota
authors: Satoshi
authors: S
authors: Kuroyanagi
authors: Takeshi
authors: T
authors: Kinoshita
authors: Noriyuki
authors: N
authors: Takashima
authors: Masato
authors: M
authors: Hayakawa
authors: Shiho
authors: S
authors: Naito
keywords: Coronary revascularization; coronary artery bypass; gastroepiploic artery (GEA); internal thoracic artery (ITA); off-pump coronary artery bypass (OPCAB)
references: Circulation. 1998 Nov 10;98(19 Suppl):II1-6
references: 9852872
references: Ann Thorac Surg. 2011 Apr;91(4):1159-64
references: 21440138
references: Ann Thorac Surg. 2002 Nov;74(5):1715-7
references: 12440647
references: J Thorac Cardiovasc Surg. 1999 May;117(5):855-72
references: 10220677
references: Ann Thorac Surg. 2013 Jul;96(1):90-5
references: 23731609
references: Circulation. 2011 Sep 13;124(11 Suppl):S130-4
references: 21911802
references: Ann Thorac Surg. 2000 Jul;70(1):307-8
references: 10921739
references: J Thorac Cardiovasc Surg. 2007 May;133(5):1220-5
references: 17467433