Step-by-step harvesting of various grafts for coronary artery bypass surgery

2021 ◽  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Left Internal Mammary Artery ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Graft Patency ◽  
Harvesting Technique

One of the key aspects to obtain good long-term outcomes after coronary artery bypass grafting is graft quality. Meticulous graft harvesting is an important technical aspect in successfully performing high-quality coronary surgery and is associated with improved long-term graft patency. Hence, developing surgical skills in this necessary surgical step is of utmost importance in coronary bypass surgery. The following video tutorial presents a step-by-step audiovisual description of the skeletonized harvesting technique of the left internal mammary artery, open and endoscopic radial artery harvesting, and open saphenous vein graft harvesting.

Graft Patency after Robotically Assisted Coronary Artery Bypass Surgery

2019 ◽  
Vol 14 (2) ◽  
pp. 117-123 ◽  
Author(s):  
Hiroto Kitahara ◽  
Sarah Nisivaco ◽  
Husam H. Balkhy
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Graft Patency ◽  
Robotic Assisted

Objective With advances in robotic instrumentation and technology, both robotically assisted minimally invasive direct coronary artery bypass (RMIDCAB) and totally endoscopic coronary artery bypass (TECAB) have been widely used over the past 20 years. Graft patency is the most important outcome in coronary bypass surgery and is associated with long-term prognosis. In this article we reviewed all experts’ studies in the field of robotic assisted coronary artery bypass and investigated graft patency in patients who underwent RMIDCAB or TECAB. Methods We performed a literature search in PubMed from 1999 to 2018 using the terms “Robotic” and “Coronary bypass” and/or “Minimally invasive” and/or “Totally endoscopic.” Of the articles found, studies investigating graft patency were specifically selected. Results In 33 articles, a total of 4,000 patients underwent robotic assisted coronary artery bypass surgery either by a RMIDCAB (2,396) or by a TECAB (1,604) approach. The graft patency was assessed by invasive angiography or computed tomographic angiography in all studies. The mean graft patency at early (<1 month), midterm (<5 years), and long-term (>5 years) follow-up was 97.7%, 96.1%, and 93.2% in RMIDCAB and 98.8%, 95.8%, and 93.6% in TECAB, respectively. Conclusions The graft patency of robotic assisted coronary artery bypass was equivalent to reported outcomes of the conventional approach. These results should encourage the adoption of robotic approaches in coronary bypass surgery.

scholarly journals Early Patency Evaluation of New Distal Anastomotic Device in Internal Mammary Artery Grafts Using Computed Tomography Angiography

2010 ◽  
Vol 5 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Husam H. Balkhy ◽  
L. Samuel Wann ◽  
Susan Arnsdorf
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Internal Mammary Artery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Graft Patency ◽  
Internal Mammary

Introduction Traditional coronary artery bypass grafting is performed using a hand sewn technique. The C-Port xA and Flex A anastomotic stapling devices (Cardica Inc., Redwood City, CA) were cleared by the Food and Drug Administration for use in distal coronary anastomoses in November 2006 and April 2007, respectively. They provide the ability to create a compliant, consistently reproducible, and automated anastomosis. Multidetector computed tomography (CT) has been shown to be effective in evaluating coronary artery bypass graft patency. Methods The first 24 patients to undergo internal mammary artery (IMA) anastomosis using the automated device in our practice were included in the study. Twenty-five IMA grafts (24 left IMA and 1 right IMA) were created using the C-Port xA or Flex A anastomotic device as part of multivessel off-pump coronary revascularization by sternotomy. Graft patency was evaluated at 30 days in the first 10 grafts and at 90 days in the next 15 grafts using multidetector (64 slice) CT. Results There were no device failures. There were no perioperative strokes, myocardial infarctions, or deaths. All 10 IMA grafts evaluated at 30 days were patent using multidetector CT. One of the 15 IMA grafts studied at 90 days was occluded using multidetector computed tomography. Conclusions The C-Port xA and Flex A distal anastomotic devices provided a safe and effective means to create a left IMA-left anterior descending artery anastomoses in coronary bypass surgery with excellent short to midterm patency in this early experience. Long-term follow-up is warranted. These findings will have important implications for future sternal sparing coronary bypass surgery.

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