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

2010 ◽  
Vol 13 (1) ◽  
pp. 36
Author(s):  
Federico Benetti ◽  
Sotirios Prapas ◽  
Ernesto Angeletti ◽  
Jose Luis Ameriso ◽  
Eduardo Cicalle ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Distal Part ◽  
Left Internal Mammary Artery ◽  
The Other ◽  
Invasive Technique ◽  
Complete Revascularization ◽  
Internal Mammary ◽  
Technical Details ◽  
The Mean ◽  
The Right

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.Operative Technique: 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.Conclusion: This minimally invasive technique is a useful alternative for complete revascularization. The sternal mammary supply and the upper part of the sternum are preserved.

λ graft with the radial artery or free left internal mammary artery anastomosed to the right internal mammary artery: flow dynamics

2001 ◽  
Vol 72 (4) ◽  
pp. 1275-1281 ◽  
Author(s):  
Edvin Prifti ◽  
Massimo Bonacchi ◽  
Giacomo Frati ◽  
Piero Proietti ◽  
Gabriele Giunti ◽  
...  
Keyword(s):  
Radial Artery ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Flow Dynamics ◽  
Free Left ◽  
Internal Mammary ◽  
The Right ◽  
Artery Flow

The GraftConnector Experience

Swiss Surgery ◽  
2001 ◽  
Vol 7 (5) ◽  
pp. 209-210 ◽  
Author(s):  
Piergiorgio Tozzi ◽  
Jan Otto Solem ◽  
Boumzebra ◽  
Antonio Mucciolo ◽  
Xavier Mueller ◽  
...  
Keyword(s):  
Internal Mammary Artery ◽  
Long Term Results ◽  
Sheep Model ◽  
Adult Sheep ◽  
Internal Mammary ◽  
The Mean ◽  
The Right

Background: A device to perform sutureless end-to-side coronary artery anastomosis has been developed by means of stent technology (GraftConnector). The present study assesses the long-term quality of the GraftConnector anastomosis in a sheep model. Methods: In 8 adult sheep, 40-55kg in weight, through left anterior thoracotomy, the right internal mammary artery (RIMA) was prepared and connected to the left anterior descending artery (LAD) by means of GraftConnector, on beating heart, without using any stabiliser. Ticlopidine 250mg/day for anticoagulation for 4 weeks and Aspirin 100mg/day for 6 months were given. The animals were sacrificed after 6 months and histological examination of anastomoses was carried out after slicing with the connector in situ for morphological analysis. Results: All animals survived at 6 months. All anastomoses were patent and mean luminal width at histology was 1.8 0.2mm; mean myointima hyperplasia thickness was 0.21 0.1mm. Conclusions: Long-term results demonstrate that OPCABGs performed with GraftConnector had 100% patency rate. The mean anastomotic luminal width corresponds to mean LAD's adult sheep diameter. We may speculate that myointima hyperplasia occurred as a result of local device oversizing.

Complete Coronary Revascularization via Left Anterior Thoracotomy

2019 ◽  
Vol 14 (4) ◽  
pp. 330-341 ◽  
Author(s):  
Oleksandr Babliak ◽  
Volodymyr Demianenko ◽  
Yevhenii Melnyk ◽  
Katerina Revenko ◽  
Liliya Pidgayna ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Minimally Invasive ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Operation Time ◽  
Internal Mammary ◽  
The Mean

Objective Our aim was to develop the minimally invasive coronary artery bypass grafting (CABG) technique, which is equally effective and safe compared with conventional coronary grafting technique, is reproducible, and can be applied in the vast majority of patients with isolated coronary artery disease. Methods From July 2017 to November 2018 a total of 170 nonselected consecutive patients underwent minimally invasive on-pump multivessel CABG through the left anterior minithoracotomy in the fourth intercostal space using a Chitwood clamp and blood cardioplegia. We named this technique total coronary revascularization via left anterior thoracotomy. The mean number of grafts was 3.1 ± 0.7. Left internal mammary artery was used in 159 (93.5%) patients, right internal mammary artery in 4 (2.4%) patients, radial artery in 25 (14.7%) patients, and veins in 148 (87%) patients. Results We had no mortality, no postoperative myocardial infarcts, and no conversion to sternotomy. There were 2 postoperative strokes without residual neurological deficit and 2 revisions for postoperative bleeding. The total operation time was 258.8 ± 43.9 minutes, cardiopulmonary bypass time 135.8 ± 26.6 minutes, and aortic cross-clamp time 71.2 ± 19.4 minutes. The mean intensive care stay was 2.1 ± 0.56 days and mean total hospital stay 6.3 ± 1.3 days. Conclusions Complete coronary revascularization could be routinely performed using the above-mentioned technique. No patient selection, based on number of grafts, quality and location of coronary vessels, left ventricle function, age, gender, or body mass index, is required.

Defining the Learning Curve for Robotic-Assisted Endoscopic Harvesting of the Left Internal Mammary Artery

2013 ◽  
Vol 8 (5) ◽  
pp. 353-358 ◽  
Author(s):  
Jonathan M. Hemli ◽  
Lucas W. Henn ◽  
Christopher R. Panetta ◽  
Jenny S. Suh ◽  
Scott R. Shukri ◽  
...  
Keyword(s):  
Learning Curve ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Learning Curves ◽  
Coronary Surgery ◽  
Harvest Time ◽  
Robotic Assisted ◽  
Internal Mammary ◽  
The Mean ◽  
Robotic Instruments

Objective Robotic-assisted techniques are continuing to cement their role in coronary surgery, particularly in facilitating the endoscopic harvesting of the left internal mammary artery (LIMA), regardless of how the subsequent bypass grafting is performed. As more surgeons attempt to become trained in robotic-assisted procedures, we sought to better define the learning curve associated with robotic-assisted endoscopic LIMA harvest. Methods Between January 2011 and July 2012, a total of 77 patients underwent robotic-assisted minimally invasive direct coronary artery bypass surgery at our institution. The LIMA was harvested endoscopically in all patients, using standard robotic instruments, followed by direct grafting to anterior wall myocardial vessels via a small thoracotomy. Intraoperative times for various components of the procedure were collated and analyzed. Results The mean ± SD time taken to insert and position the ports for the robotic instruments was 3.9 ± 1.4 minutes. The mean ± SD LIMA harvest time was 31.8 ± 10.1 minutes, and the mean ± SD total robotic time was 44.2 ± 12.9 minutes. All time variables consistently continued to decrease as the experience of the operating surgeon increased, with the greatest magnitude of improvement being evident within the first 20 cases. The logarithmic learning curves for LIMA harvest time and total robot time during our entire experience were both calculated as 90%, correlating to an expected 10% improvement in performance for each doubling of cases completed. Conclusions Coronary surgeons can rapidly become proficient in robotic-assisted endoscopic LIMA harvest, with significant improvement in operative times evident within the first 20 cases completed. These data may be useful in designing appropriate training programs for newer surgeons seeking to gain experience in robotic-assisted coronary surgery.

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