title: Bailouts to LIMA Damage for Avoiding Conversion in Minimal Access Coronary Procedures.
abstract: Minimally invasive and robotic coronary revascularization strategies offer less pain, fewer adverse events, better cosmesis, and speedier recovery. These procedures are vulnerable to left internal mammary artery (LIMA) injury that may require a full sternotomy, which eliminates the benefits of minimally invasive procedures. We present a management protocol to avoid conversion to sternotomy in minimally invasive cases based on the location of the LIMA injury at proximal, mid, and distal locations. By applying axillary bypass, LIMA extension, and repair over a shunt approaches, our protocol can be used as a successful bailout to LIMA damage in minimally invasive coronary cases.
authors.affiliation: Department of Cardiothoracic Surgery, Imperial College London, London, United Kingdom. Electronic address: t.athanasiou@imperial.ac.uk.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Department of Cardiothoracic Surgery, Imperial College London, London, United Kingdom.
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.affiliation: Department of Cardiothoracic Surgery, Imperial College London, London, United Kingdom.
authors.forename: Leanne
authors.initials: L
authors.lastname: Harling
authors.affiliation: Department of Cardiothoracic Surgery, Imperial College London, London, United Kingdom.
authors.forename: Roberto P
authors.initials: RP
authors.lastname: Casula
mesh_terms: D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008323:Mammary Arteries / Q000637:transplantation*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012371:Robotics / Q000379:methods*; D056346:Sternotomy