Related Experiment Videos
[Minimally invasive direct coronary artery bypass performed via diaphragmatic approach]
M Minakawa1, K Takahashi, N Kondo
1Department of Cardiovascular Surgery, Aomori Rhousai Hospital, Hachinohe, Japan.
Insights
The diaphragmatic approach for coronary artery bypass grafting (CABG) to the right coronary artery demonstrated successful graft patency in 18 patients. This technique is particularly beneficial for reoperative CABG, avoiding injury to existing grafts.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Context:
- Coronary artery bypass grafting (CABG) is a common procedure for ischemic heart disease.
- Reoperative CABG presents unique challenges, including the risk of damaging previously placed grafts.
- The right coronary artery is a critical target for bypass surgery.
Purpose:
- To evaluate the efficacy and safety of a diaphragmatic approach for CABG specifically targeting the right coronary artery.
- To assess graft patency and clinical outcomes in patients undergoing this novel surgical technique.
- To explore alternative grafting strategies for patients with specific anatomical or surgical histories, such as prior gastrectomy.
Summary:
- Eighteen patients (13 male, 5 female; age 47-81) underwent CABG via a diaphragmatic approach for the right coronary artery between October 1996 and August 2000.
- Ten patients required reoperative CABG. The right gastroepiploic artery was the primary conduit (16 cases), with radial artery or saphenous vein grafts used in one case.
- Bypass targets included segment 3 (9 cases), right posterior descending artery (8 cases), and right atrio-ventricular branch (1 case). All grafts were patent on postoperative cardiac catheterization.
Impact:
- The diaphragmatic approach offers a valuable alternative for right coronary artery bypass grafting, especially in reoperative cases, by minimizing the risk of injury to existing grafts.
- This technique provides a viable option for patients who have undergone gastrectomy, utilizing grafts from the gastroduodenal artery.
- Successful graft patency suggests the diaphragmatic approach is a safe and effective method for achieving revascularization of the right coronary artery.
Abstract:
From October 1996 until August 2000, coronary artery bypass grafting (CABG) for right coronary artery was performed via diaphragmatic approach. This procedure was done in 18 patients consist of 13 male and 5 female ranging in age from 47 to 81 years old. Ten of 18 cases were performed coronary bypass reoperation. Right gastroepiploic artery was used in 16 cases, and branched radial artery or saphenous vein graft from gastroduodenal artery was used in one case. Bypassed region in right coronary artery was segment 3 in 9 cases, right posterior descending artery in 8 and right atrio-ventricular branch in one. All grafts were patent in postoperative cardiac catheterization. This approach was desirable for the case, which bypass grafting to right coronary artery is necessary, on account of avoiding injury of patent bypassed graft by median sternotomy in re-do CABG. For the patient whose stomach had been resected, bypass grafting from gastroduodenal artery with radial artery or saphenous vein graft to right coronary artery is useful procedure.